I’m a Physician Associate working in central London. I work in Haematology, specifically haemto-oncology (which is all things blood cancer) but I also cover general haematology as well. Ask me anything…
I’ve not yet had the opportunity to work alongside a PA, so I’d be interested to hear what an average day for you currently involves, in terms of the tasks you carry out and how you work with the rest of the multidisciplinary teams?
Hey @lewis, awesome question! And one I get asked relatively frequently…
My typical day starts at around 8.15am (although I was actually up at 5.30am). I don’t officially start work until 09.00, but through a combination of train timings and workload I get in to work early. I sit down at my desk, with a coffee and my bowl of cereal, and open up our ward handover list. I go through each patient and update their plans, chemotherapy regimens and antimicrobials. I check the handover email and add all new admission to our list. Then I remotely review all of the patients who were unwell from overnight via out electronic eNoting system. This is a vital part of my role as a PA…
- Alleviating administrative tasks from our junior doctors
- Knowing all of our patients really well
As the PA, I am the continuity. Other than the Consultants, I’m the only member of the medical team who remains constant - everyone else changes every 3-6 months, depending on their role. The Registrars tend to ask/expect from me a rapid update from the overnight events when they get back from morning teaching at 09.00am.
Then we start war rounds. Twice weekly they are directly lead by the Haem Consultant, where I spend most of my day updating the Consultant on the events from the previous couple of days, checking bloods, documenting the ward round entries and completing jobs (such as chasing investigations, writing discharge summaries or reviewing suddenly unwell patients). The rest of the week we spilt the ward round amongst ourselves - that is, I assign 5-6 patients per team member (2x CMTs, 1x PA, 1x SpR) and off we go to review and make that patients plan for the day.
I carry out a ward round no differently to anyone else - the difference being I know the patients really well because I’ve known them for the last 12 months (some of them now). Because of this I am aware of their past issues/complications during chemotherapy as well as their individual needs. I am often called upon by the doctors for advice on both inpatients and outpatients because of this. I complete my ward rounds, make a plan and then we all meet up just before lunch (around 12.30-1pm). We then all run through our patients with the Haem Reg and we generate our jobs list for the afternoon.
It’s then off to lunch (which usually is eating at our desk, but every Tuesday there is a Farmers Market outside the university across the road and we can be found there!).
After lunch its time to crack on with the jobs. For me the bulk of my afternoons consist of chasing investigation results, writing discharge summaries, clerking new admissions and reviewing unwell patients on the ward. This is not to dissimilar to what our junior doctors do (CMT/SHO). The major difference being is that currently I need to ask our junior doctors to prescribe medications or blood transfusions that my patients need. Frustrating, to say the least.
About 6 months in to my role I was started to be trained up in performing bone marrow biopsies. This is where we take some cells and an actual biopsy sample of a patient’s bone. I now perform these independently, with remote supervision from my Consultant. These are usually on inpatients, but due to demand on services I am also often called to perform urgent bone marrows for outpatients.
I have also started to carry out Urgent Suspected Cancer Referral clinics (also known as 2 week waits). This is where, usually a GP/GP PA, has referred a patient to us because they believe the patient may have a suspected haematological cancer. I am currently at the shadowing/being watched phase, whereby my Consultant is shadowing me and showing me how the clinics work. In the next month I will start seeing patients on my own. At the end of every clinic the clinic Reg and SHO run all of their patients past the Consultant, which is what I will also do in the future.
I (should) finish at 5pm, but more often than not I am still at work till around 6pm. It use to be a lot later and we use to leave around 7-8pm every day. Since I have joined the team, because we can share the workload, we now only finish around 30minutes late. Still, room for improvement.
I do a tonne more, such as reply to the 30 million emails I get from 6am - 11pm (yes, I check my emails at both of those times) as well as spend my evenings worrying about my patients. Building strong relationships with the people under my care really means there is no way you can’t take your work home with you - and on the occasional day where I am not at work, I phone in to check up on everyone.
So that’s me in a nutshell. I’m always happy to discuss more, or answer any questions/queries you might have about my role
This is a great point, there really is a lot of value to having some degree of continuity in a team, both from a safety and efficiency point of view. I previously worked as a locum neurosurgical SHO for a year on a single ward and it became apparent just how much more value I could provide to the rotating junior doctors and registrars, purely because I’d seen the patients consistently, sometimes for months. This meant I could quickly give an update of outstanding investigations, current treatments, clinical progress and discharge plans without needing to trawl back through 20 pages of patient notes.
This is the bulk of the work that is often crushing the single F1 on the ward (speaking from personal experience). My life as a new junior doctor would have been a lot more tolerable if I’d had a great PA to provide some ward context when I’d first started and been able to share the task load with me.
It sounds like you are getting to be involved with a diverse set of roles within the team. Sadly, as a junior doctor, the clinic was often completely out of reach due to the need to keep on top of the ward tasks. Hopefully, as we get more PAs, the ward pressures would be eased allowing a more diverse learning experience for all of us.
Sadly, I can’t promise this ends. I’m 7 years into practising and it still happens (although definitely less than it used to).
Well, it was great to get some insight into the day of a haematology PA! It sounds like a fantastic, interesting and fulfilling role that benefits the whole multi-disciplinary team and patients alike.
Thanks for sharing Jamie!
Great question, I found this really interesting to hear from a PA’s perspective
Indeed. As a PA whilst we gain in-depth speciality knowledge with time spent in our speciality, we do not ‘progress up the ranks’ if you were i.e. I’m not going to be a Registrar and therefore will most likely remain ward based alongside our SHOs life long. But of course, a lifetime of discharge summaries and cannulas does not fill me (or anyone else) with much drive. Whilst these tasks will remain a large part of my role for most of my career, progression through more responsibility (such as independent procedures and clinics) is one way to keep my interest and continued drive. Anyone in medicine craves more, and PAs are no different I’m pleased to say.
On a positive note, because I am now on the ward, our CMTs get allocated set clinic days to ensure that they can meet their minimum clinic hours. More often than not if there are 3 SHOs and me (and the dedicated ward SpR) then we take it in turns for one of them to head off to clinic or a procedure list.
A lot of junior doctors were worried about PAs ‘stealing’ opportunities from them. If anything, they now get to do more than ever before. I also take them along with me to see bone marrow biopsies (and in the future, once we are regulated, teach our SHOs/CMTs how to do them).