Category: Physician

With increasing people being diagnosed with terminal illnesses, there is an increase in the number of patients who try to seek out a way to get rid of or fix their illness. Doctors use experimental medications for some, while the others are told about the few months they have, to live. However, doctors also have an option of Physician Assisted Suicide. The definition of assisted suicide is: A physician providing medications or other means to a patient with the understanding that the patient intends to use them to commit suicide. Assisted Suicide has throughout history caused controversy among the society. This issue has two sides, one that passionately supports it and the other that disagrees with it. I think Physician-Assisted Suicide is a practical solution to the problem of terminally ill patients, and hence should be legal.

Most of the people get confused between Physician Assisted Suicide and Euthanasia. There is a thin line of difference between the two. Euthanasia is when the physician takes an active role in carrying out the patient’s request, which usually involves intravenous delivery of a lethal injection or by withdrawing the ventilator support. Physician-assisted suicide seems easier emotionally for the physician than euthanasia as they don’t have to directly cause a death. While Physician-assisted suicide has a benefit of allowing the patient to figure the time of death, it still does carry the risk of error, and the process needs to be completed while the patient is still well enough to swallow and metabolically absorb these drugs. However, Euthanasia has a much smaller chance for mistakes as it is assisted by the physician and is necessary in cases where a patient is too sick for self-administration or is no longer capable of swallowing or absorbing oral medication.

The next question which arises is that why do patients request Physician Assisted Death when it may carry a risk of error? The answer is simple, they believe that being alive is pointless. They feel weak, tired and uncomfortable all the time. They also might be going through, depression or socioeconomic stressors about being a burden to their family members economically and mentally. An article was published in the New England Journal of Medicine on 22 August 2002, which talks about the ‘Experiences of Oregon Nurses and Social Workers with Hospice Patients Who Requested Assistance with Suicide.’ The article stated that “According to the hospice nurses, the most important reasons for requesting assistance with suicide, among patients, was the desire to control the circumstances of their death, a desire to die at home and the pain and fear of pain. Depression and other psychiatric disorders, lack of social support and other physical symptoms, such as fatigue and dyspnea, were reported to be only moderately important reasons for the request. Seventy-seven percent of the nurses reported that patients who received prescriptions for lethal medications were more fearful of loss of control over the circumstances of death, whereas 8 percent reported that such patients were less fearful than other hospice patients. Sixty-two percent of the nurses said that patients who received prescriptions for lethal medications were more likely to be concerned about loss of independence, whereas 9 percent said that such patients were less concerned about loss of independence than were other hospice patients. Only 15 percent of the nurses, however, reported that the patient had more pain, on average, than other hospice patients.”

As mentioned before, assisted suicide has led to a lot of controversy. There are a bunch of people against the idea of making Physician Assisted Suicide legal. They argue that authorizing suicide as a ‘choice’ for some people soon ends up pressurizing them ‘to do the right thing’ that is to kill themselves. This undermines the willingness of doctors and the society to show compassion and address the pain and other problems the patients suffering from. So, they believe that the only solution is, to take care of the people and to assure them that they are not a burden and it is a privilege to care of them as long as they live.

On the other hand, the people who support the idea of legalizing assisted suicide argue that the right to die should be a matter of personal choice. Because if one was able to make all types of decisions throughout their life – from selecting friends to deciding what kind of work they want to do, then they should also have the right to make a choice, whether they have a terminal illness or not, to end their life. The second argument between the two groups is regarding financial motivations. Some people question the motives of the insurers that whether they will do the right thing or not.

The role of a PA

Role of a Physician Associate

The role of a Physician Associate (PA) often creates a question that demands the definition of PAs since the introduction of PAs in the 1950s (Braun et al., 1973). Physician associates are medically trained professionals who are generalists within the healthcare industry. A PA’s role is to work alongside doctors and provide patient care as an integral part of the multidisciplinary team. Physician associates are practitioners who work with a dedicated medical supervisor but are cable of working autonomously with appropriate support. Faculty of Physician Associates (31052021) Who are physician associates?, Available at https:www.fparcp.co.ukabout-fpaWho-are-physician-associates (Accessed: 31052021).

The United State of America introduced the first formal program of Physician associates at Duke University, from which 68 PAs graduated in the year 1965 (Braun et al., 1973). According to the Department of Health, the official definition of the role of a PA is (2012): ”A new healthcare professional who, while not a doctor, works to the medical model, with the attitudes, skills and knowledge base to deliver holistic care and treatment within the general medical andor general practice team under defined levels of supervision. (RCP: FPA, 2012). The main aim of the roles of a PA is to reduce the pressures experienced by doctors and to offer a continuity of care to patients (Joyce et al., 2018; NHS, 2017b). By 2020 there have been approximately 1,000 PAs practicing in the UK with many more in training (NHS, 2020a; RCP: FPA, 2017; Ritsema et al., 2019).

Physician associates have an important role to play in primary and secondary care as part of a multi-skilled team, working alongside pharmacists, advanced nurse practitioners, doctors, and consultants. They provide a continuity of care for patients especially those who have long-term conditions, which patients value as there is a decreased need to repeat medical histories.

PAs were initially introduced to the US as a response to a shortage of workforce within the primary and secondary healthcare service. However, PAs have faced negative scrutiny within the public domain. PAs were seen as an inexpensive substitute for Doctors. This negative image made it extremely difficult to allow the effective integration of PAs into the NHS. These concerns were mainly down to questioning the effectiveness of PAs, in comparison to junior Doctors. As a PA student, I have also experienced impediments throughout various clinical placements. However, the integration within the team was assuaged with the support of staff and patients. Integration and acceptance of PAs have always been difficult, but with time both staff and patients have observed the benefits of PAs. These benefits have been illustrated by PAs in both primary and secondary care through reduction of frontline pressure, decreased waiting time, depletion in shortage of staff, and building a trustworthy rapport with the patients. This has eased the integration and acceptance of PAs within the NHS and public domain. In summary, PAs are referred to as the helping hand that expedites access to healthcare services.

In the UK the profession of physician associate is considered a new role that was initially introduced in the country in 2003.

The role of physician associate first developed in the US in the 1960s, known as a physician assistant, and similar roles under different names exist in many healthcare systems around the world. There has been an increase in patient satisfaction in response to the role of PA. In 2004, the Department of Health evaluated the impact of introducing the role of physician associate, where a higher level of clinical satisfaction was noted. In 2005, the UK Association of Physician Associates (UKAPA) was established which now acts as a professional body for physician associates. Following this, in 2006 the Department of Health

The profession has gained great success and popularity in the UK with the addition of the voluntary register for physician associates in 2011, and the launch of the Faculty of Physician Associates through collaboration with UKAPA and the RCP in 2015.

Faculty of Physician Associates (31052021) Who are physician associates?, Available at https:www.fparcp.co.ukabout-fpaWho-are-physician-associates (Accessed: 31052021).

PAs are to assist in providing a robust NHS workforce, a broad and inclusive practice of care, a sufficient work-based learning environment, and supervision. However, Reid (2008) highlights that introduction of new roles may not be a swift and complete solution to the increasing demand and pressure of the current NHS climate but instead, an in-depth assessment of patient’s medical needs should be the priority. A key barrier that has been highlighted in myriad studies is the integration, acceptance, and recognition of such roles, especially PAs in the NHS workforce and public view (Adamson, 1971; Aiello, 2017; Brown et al., 2019; Drennan et al., 2019).

‘They function as mid-level practitioners, along with doctors in training and nurse practitioners

Physician assistants were first employed in the United Kingdom in 2003, working in primary care in the West Midlands

Stewart A, Catanzaro R. Can physician assistants are effective in the UK? Clin Med2005;5:344-8

n the UK they now work mainly in hospitals in a wide range of specialties, predominantly general medicine and the emergency department but also in surgery and in smaller specialties such as pediatrics and oncology

Ross N, Parle J, Begg P, Kuhns D. The case for physician assistants. Clin Med2012;12:200-6.

The scheme was evaluated qualitatively through a retrospective questionnaire. This incorporated open questions on the role of physician assistants in psychiatry, the advantages of employing physician assistants, and any issues that had arisen. These were distributed to the physician assistants, their respective consultants, a non-medical team member, and any attached junior doctor.

Before physician assistants were employed, the clinician’s initial concerns were that:

The team would have a limited understanding of the role of the physician assistant

Physician assistants would not have enough psychiatric knowledge

Physician assistants would be unable to prescribe.

All those approached replied to the questionnaire: five responses were from physician assistants, six from consultants, five from non-medical team members, and four from junior doctors (ranging from foundation year 1 to core training year 3).

The UK National Health Service is funded by UK citizen taxation and provided by the government and is comprised of primary care facilities that offer healthcare for ‘general’ diseases and secondary and tertiary care providers that offer specialist care. Physician associates (PA) are medical professionals with generalist medical knowledge who work under a doctor’s supervision to form a multidisciplinary team within these facilities. The occupation was introduced to help alleviate the pressures on healthcare due to high workloads and doctor shortages. The PA is a relatively novel position within the healthcare system capable of influencing healthcare and will be discussed further in this essay.

Influence on Patient Healthcare and Patient Flow

The PA can influence patient flow through a healthcare facility due to their extensive clinical duties like taking medical histories, conducting physical examinations, requesting and interpreting investigations, performing venipunctures, admitting and discharging patients, diagnosing and treating diseases. These responsibilities can help determine whether a patient is moved, admitted, or discharged. This shows that the PA can offer aid in managing patient workloads.

Medical Model

The PA is trained to the medical model, meaning they can identify and diagnose pathologies with complex clinical presentations; this is beneficial to secondary care healthcare teams as the PA can give valuable medical knowledge to colleagues and patients. It is also of benefit to primary care as the PA, based upon the pathologies they are observing, can refer patients to the appropriate specialist healthcare facility.

Importance of Autonomy

The PA can help support the workloads of doctors. This is because they can fulfil some clinical duties a doctor has due to their extensive medical knowledge and their degree of autonomy whilst under supervision. This frees up the doctor’s time to focus on more complex or sick patients. This ability of the PA, therefore, can be valuable to the healthcare system.

Limitations to Patient Care

The PA is a new profession, and many patients are unfamiliar with what they are and their duties. This can influence a patient’s decision not to be seen by a PA, but by a doctor instead. Currently, PAs lack statutory regulation; therefore, they cannot request diagnostic ionizing radiation (like X-ray, MRI and CT scans) and cannot request prescription medication without a doctor’s signature. This can be an inconvenience, as the PA may have to wait for the doctor to be available for the signature, which could slow patient care. Discharges dependent on medication prescriptions could also be affected.

Conclusion

The PA profession was implemented to aid with the current pressures in healthcare. The PAs varied clinical duties, medical knowledge and level of autonomy enables them to positively affect healthcare and the issues like doctor shortages and high workloads. However, the PA’s clinical potential and ability to influence patient care further is limited as they lack statutory regulation. Future changes are needed to these regulations to advance their functionality in healthcare.

Accessibility to quality health services is important for the upgrading of results. Vulnerable groups in upcountry and inner-city zones have inadequate access to general practitioner and compulsory medical inputs. In contrast, urban regions enjoy an oversupply of medical doctors. The geographic disparities in the spreading of physicians have led to the uneven improvement of health amenities and an overall reduction in life expectation for the residents in countryside. This essay focuses on the causes of maldistribution of health workforces and the promising solutions to reduce the imbalance.

There is a wide range of factors that determine the topographical distribution of general practitioner. First, are individual factors like social background, values, gender age, beliefs and education, which have significantly contributed to inequality in the scattering of medical employees. Consistent with Xierali et al. (2018), more doctors tend to settle in cities owing to the conducive environment for specialized growth in towns as opposed to remote areas. Furthermore, the increased number of women in the profession has led to the regional imbalance in the distribution of medics. Since many women prefer working in urban zones hence rejecting rural placements, a high number of female graduates cannot automatically lead to an increase in general practitioner in the remote regions.

In 2017, Rajbangshi et al. realized that organizational environment could influence the physical dispersal of physicians. Poor compensation and unsatisfactory job settings in remote parts scare off most medical practitioners. Doctors, like other experts, supplement their incomes by use of various strategies including private contracts. Towns offer a wide range of prospects for doctors to work part-time as opposed to country areas. Additionally, a lack of suitable amenities in rural areas discourages doctors from accepting to work there. Lack of transparency, especially in the posting of vacant promotions in remote parts, has contributed to the outflow of doctors from country to urban. Generally, poor infrastructure has deterred health specialists from accepting job offers in remote regions.

National institutions can determine the dissemination of health workers. For instance, a salary structure that fixes the salary of all staff regardless of variances in workload and working settings can inhibit medical personnel from working in remote places. This system discriminates against physicians practicing in remote areas who work for long hours under unsatisfactory conditions. Lack of motivation to work amongst the workforce in rural areas will result in migration to urban in search of better working conditions. Political currents can also influence the distribution of health workers. Remote areas that are prone to insecurities have low numbers of medical doctors compared to secure areas. Metropolitan regions are well equipped with security personnel, thus attracting more doctors to work in town.

One can deploy a wide range of strategies to restore balance in the geographical distribution of physicians. Reforming medical schools to produce graduates who are prepared to work in remote areas is the initial step. Reforms should focus on the production of family doctors, not hospital-based doctors. Establishment of a compulsory rural internship can reduce the imbalance since medical doctors can opt to work in the rural area after the internship. Also, educational subsidies to rural staff which seeks to specialize in areas that will benefit the community can encourage more doctors to work in remote areas (Zhu et al., 2019). Therefore, adequate investment in the shaping of medical students to work in remote areas is vital.

Adopting rural recruitment and training can reduce the imbalance in the distribution of medical staff. In this strategy, recruitment of medical students necessitates that students must sign a contract that obliges them to work in a rural area after graduation for a specified duration. Moreover, students conduct their internships in the remote area where they will work once they graduate for the familiarization (Humpreys et al., 2017). Establishment of well-equipped medicinal schools, hospitals and clinics throughout a country is crucial for the success of this strategy.

In 2017, Behera et al. disclosed that motivating general practitioner in unattractive areas by offering incentives can greatly reduce the disparity in the ecological scattering of doctors. Multiple profits for instance, study and recreational leaves, allowances, developed social amenities and bonuses based on working hours. Supporting medical practitioners in remote areas to advance their studies by paying part of their fee can motivate them to work and attract more in the region. Salary increment, especially to physicians working in hardship areas, can act as bait, thus pulling more staff from urban areas to offset the imbalance. Encouraging health employees to work as private staff in various institutions to supplement their salary will reduce rural-urban migration in search of private side job.

According to Mlambo et al. (2018), decentralizing the location of health schools and other tertiary services is important in ensuring the equal distribution of physicians. Standardization of training institutions throughout a country in terms of infrastructure, staff and quality of education is important. The institutions should equally embrace new educational tools such as the use of videoconference, which can also be used in rural areas for training and as a treatment tool. Security personnel must be deployed to remote areas to assure safety to the staff. Generally, development must be decentralized to encourage the balanced distribution of medical workers.

In conclusion, gender disparity can cause immense inequities in the dispersal of physicians since females tend to avoid working in countryside. Low salary and poor working conditions discourage physicians to accept jobs in isolated areas. Enthusiasm to work is thus key in the rural health sector. Incentives and proper working conditions are elementary motivators to physicians in rural areas. Moreover, a good salary can attract and retail workers in remote areas, thus correcting the unevenness in the spreading of the medical staff.