Originally posted on Reddit and reposted with permission. Edited and reformatted for grammar and clarity.
Tonight, I spent four hours with my 6-month-old for an upper respiratory tract infection (URTI), wanting to rule out anything serious, and because she had forcefully vomited and was not feeding well. Of course — right before Thanksgiving.
After finally getting roomed, I remembered to ask if we’d be seen by a physician. Our amazing nurse tells us that a PA would be right in. I nicely explained that we were requesting that she only be evaluated by a physician and not a midlevel in such a high-acuity setting. The nurse did push back some, insisting that they worked together, to which I said, "There is no way to know how much supervision is done and he [the physician] will not be evaluating my daughter, but taking the PA's word." With more pushback, I cited recent deaths and malpractice cases. “Doctors make mistakes too.” “Yeah, but I’d rather have the highest trained make the mistake than hate myself for the rest of my life because a midlevel made the mistake.” After citing state laws regarding liability being on the physician and her not being held accountable, then finally invoking my right to be seen by a physician in my best Karen voice, he agreed.
So, the nurse informed the PA and the attending physician. The PA enters. “Weird,” I thought. Maybe she was coming in to assure us that the attending physician would be in shortly? Nope — she began the encounter as if nothing had happened. I said, “With all due respect, we requested that she be seen by a physician.” She responds, “Yeah, I’m the PA and we work together”. “I don't understand...I thought the nurse told you [that we had requested a physician]. That would make this a lot less uncomfortable for everyone." She continued to insist that they worked together, and I said, “I don’t want this to get personal and it doesn’t have to be. I do not consent to you evaluating my daughter. Please send a physician. She cut me off mid-sentence and walked away, saying something under her breath.
By contrast, the physician was fantastic. The nurse was incredible (as nurses always are).
What’s beyond disturbing about this encounter are three things:
- The PA assumed that despite me requesting a physician, she had the right to override my request and that her presence would make me feel intimidated into “dropping it.”
- The PA persisted after the nurse told her, and even after I personally told her to her face that I wanted a physician to evaluate my child. As a male medical student wanting to do OB/GYN, I never take it personally when women don't want to be seen by a male. I won’t when I’m an attending physician either. It’s not personal.
- The PA then took offense to this request and stormed off (like a child).
P.S. I looked this PA up afterwards. She’s been working as a PA for less than a year. The gall.
For the record — sure, I think most PAs and perhaps some NPs are perfectly competent to work up a simple URTI and rule out anything serious. Ordinarily, I would be okay with the traditional role of a PA. However, as a member of Physicians for Patient Protection (PPP) and being aware of recent gross malpractice incidents in objectively straightforward cases, neither I, nor my family will be seen by midlevels — certainly not without more oversight and regulation. More than anything, as a principle, I believe that we must all begin to stand up for ourselves as well as those who don’t quite understand what is happening.
So, I wouldn't have cared if the PA had done everything perfectly. That’s not the reason I am refusing. I don’t want to support midlevels when their governing bodies don’t care about patient safety. It’s because I believe resistance from patients is necessary for things to turn back around.