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News & Knowledge » Death of 77-year-old after misdiagnosis sparks debate on Physician Associate role
In February 2024, 77-year-old Pamela Marking went to A&E in East Surrey Hospital after vomiting blood and experiencing tenderness on her side.
She was seen by a Physician Associate (PA) who discharged her telling her she had a nosebleed. After 2 days Mrs. Marking went back to the hospital where she was then told she actually had a hernia.
The Physician Associate’s misdiagnosis proved fatal as she passed away 4 days later following complications with her care.
According to the coroner’s report, the PA:
“Had a lack of understanding of the significance of abdominal pain and vomiting and had undertaken an incomplete abdominal examination which would have been likely to have found a right femoral hernia.”
“Blurring of Roles” – Physician Associates vs Doctors
The coroner’s report, written by Dr Henderson, raised significant concerns in regards to Physician Associates. Concerns were raised over the lack of public awareness about their role, with them often being mistaken for doctors.
According to Dr. Henderson:
“This blurring of roles without public knowledge and understanding of the role of a physician associate has the potential to devalue and undermine public confidence in the medical profession whilst allowing physician associates to potentially undertake roles outside of their competency, thereby compromising patient safety.”
What is a Physician Associate?
A Physician Associate (PA) is a graduate, typically with a bio-science degree, who has then completed two years of post-graduate training.
According to NHS guidelines, PAs are required to be directed and overseen by a senior doctor. They aren’t able to prescribe medications, but they can carry out physical examinations, order scans and work with doctors to plan patient treatments.
Are Physician Associates safe? Experts weigh in
Professor Trisha Greenhalgh, an expert from the University of Oxford, has said that not a single study has been done on whether PAs are safe and that Physician Associates taking on the responsibilities of NHS doctors can “cost lives”.
According to the Health and Social Care Secretary Wes Streeting:
“There are legitimate concerns over transparency for patients, scope of practice and the substituting of doctors.”
Concerns have also been raised by the Royal College of Physicians and the British Medical Association.
Government response and ongoing investigation
In November, the Government launched an independent review of Physician and Anaesthesia Associates.
The review is being led by Professor Gillian Leng CBE, president of the Royal Society of Medicine, and will be published in Spring.
What to do if you have experienced misdiagnosis
If you or a loved one has suffered due to misdiagnosis or inadequate care, seek legal advice immediately. Visit Oakwood Solicitors’ medical misdiagnosis resource to learn about your rights.
Further reading
Medical misdiagnosis or delay – Oakwood Solicitors
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Author: Aditi Zamvar
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