‘I thought I was seeing a GP not a physician associate

Daniel Harris said he was given just 20 minutes to live when he arrived at A&E after being misdiagnosed twice by physician associates

A man who said he was given just 20 minutes to live after being misdiagnosed twice by physician associates (PAs) has welcomed a proposed ban on them diagnosing patients.

Daniel Harris, 49, from Devon, did not realise he was not seeing a doctor when he attended the appointments at his GP surgery in 2023 complaining of severe stomach pains.

His experience is not unique. A government-ordered review published last week highlighted patient confusion between the PA role and that of the doctor, and called for PAs to have their own uniform to make it obvious to patients they are not trained doctors.

Mr Harris only discovered he had been assessed by a PA when his partner looked them up online.

“It wasn’t a GP,” he said. “They don’t tell you when you go.”

While PAs are not doctors, they are still healthcare professionals. They are postgraduates who have taken a two-year course to qualify for the role and are supervised by doctors, but they can work independently with appropriate support in GP surgeries and hospitals.

During his first appointment with a PA, Mr Harris said he was examined and told the problems were a result of what he was eating.

On a second appointment with a PA, Mr Harris said he was prescribed antidepressants. He “didn’t bother” taking them as he knew he was not depressed.

‘I’m lucky to be here’

A week later he was in so much pain he ended up in A&E. “I went to hospital and then they had to operate on me in 20 minutes. I had 20 minutes to live.”

Professor Gillian Leng, president of the Royal Society of Medicine, and author of the review into physician associate and anaesthesia associate professions, found six patient deaths linked to contact with PAs have been recorded by coroners in England.

One of the patients, Emily Chesterton, 30, died from a pulmonary embolism after she was misdiagnosed by a PA on two occasions in the weeks before her death and prescribed propranolol for anxiety instead of identifying and addressing the blood clot.

Mr Harris supports the recommendation that PAs should be banned from diagnosing patients.

“It’s dangerous, to be quite honest,” he said. “I’m lucky to be here.”

While Mr Harris had been to GPs over the years about his stomach pains and not received an accurate diagnosis, some doctors had told him the issue was diet related and recommended cutting out dairy, while others said they could not find what was wrong.

However, he believes seeing PAs when the symptoms were at their most severe was the main contributor to his near-death experience – and the complications he is still dealing with today.

A week after a second appointment with a PA, he was rushed into hospital with a twisted gut. It was then that Mr Harris was diagnosed with diverticulitis, a condition that affects the large intestine, and can cause severe, constant abdominal pain and other symptoms. It is caused by small bulges or pouches in the walls of the intestine called diverticula.

“Every time I went to the doctors, I told them that my mum had diverticulitis and she’s got a stigma… and not one of them ever put the two together,” Mr Harris said.

Rea Jackson, Mr Harris’s partner, who has veterinary experience, said: “Instead of referring him to gastroenterologist they put him on amitripyline [an antidepressant], which made Dan give up. It was very frustrating knowing what was wrong with him but nobody would listen to us.”

Diverticular disease has a hereditary component and patients are more likely to develop diverticulae if they have a close relative with the condition.

It can lead to complications that require surgery.

Had he been diagnosed at his appointment with a PA around six months before the emergency surgery – or even at the second PA appointment a week before – Mr Harris believes he would have avoided further complications.

“I wouldn’t have had to have an emergency operation to start with,” he said.

In addition to the misdiagnoses, Mr Harris suffered further when his operations did not go as planned.

“They operated on me and did it wrong. And then I went back again for a reversal – they did that wrong, then I was in a coma,” he said.

“I was out four days and then I got rushed in by ambulance because I had sepsis. They couldn’t operate on me because I kept dying, basically, and they had to put me in a coma and then keep waking me up and having another go.”

Mr Harris, now has two stomas, which he described as “absolutely horrendous”. He is also suffering with two hernias.

Why is there controversy around PAs?

PAs and anaesthesia associates (AAs) were introduced into the NHS in the early 2000s as a rapid measure to reduce workforce pressures in the NHS.

Despite undergoing significantly shorter training, PAs and AAs, although to a lesser extent, have been used to fill roles designed for doctors in numerous instances.

The British Medical Association (BMA) has raised concerns over the blurring of the lines between doctors and PAs and AAs, who they say are not medically qualified, and taken the General Medical Council to court over the matter.

In response to the row over their responsibilities and high-profile patient deaths following misdiagnosis by PAs, Health Secretary Wes Streeting ordered Professor Leng’s review.

It found that while the PA role is “is working well in some places, but there indeed has been some substitution and any substitution is clearly risky and confusing for patients”.

The report made 18 recommendations, all of which the Government has accepted, Streeting said.

However, the BMA said these are not “sufficient” to protect both patients and doctors.

“I didn’t want a stoma but obviously I only had 20 minutes to live so I had no choice – but that was tough. The second time was tougher because I came out with two.”

Mr Harris has to have another two operations before he can start to put the ordeal behind him. And with a recommended recovery time of 18 months between each operation, it will be around four years before he can actually begin to do that.

The plasterer has had to give up work on doctors’ orders. “I’ll just make myself worse, because I get hernias, and I’ve only just, literally, now, actually started feeling better from the last operation.”

Not being able to work “drives me insane”, he said. It has also had a huge financial impact. Mr Harris is now in receipt of sickness benefit after recently running out of his savings. He has also had to sell prized possessions.

“I had a lovely boat and stuff on the marina, and everything’s gone. I had to get rid of it because I can’t [use it]. I can’t do anything really. I can’t earn a living.

“It’s messed my whole life up and completely stopped my whole life.”