Why Emily Chesterton is NOT a reason to get rid of Physician Associates

(And the BMA needs to stop exploiting her family)

Emily Chesterton is a beautiful, young woman who sadly died of a pulmonary embolus (PE – blood clot on her lungs) having seen a Physician Associate (PA) twice in a GP practice. Emily presented with calf pain, shortness of breath and difficulty walking. The PA concerned diagnosed anxiety and a muscle strain and treated these. Subsequently it turned out the calf pain was a deep vein thrombosis which turned into a fatal clot on the lungs. The PA concerned was immediately dismissed and has not had employment since and the GP practice concerned decided to get rid of all their Physician Associates.

The death of Emily Chesterton has been used extensively as a reason to get rid of or, at the very least, demote PAs. While Emily’s death is tragic, her death is not a reason to get rid of PAs and her death has been unreasonably exploited by the British Medical Association (BMA)

What happened to Emily Chesterton

Emily saw a PA initially and was diagnosed with a muscle strain and anxiety. In the GP setting this is not unreasonable, Emily did have risk factors for a clot but, in the GP setting, it is much more difficult to make a diagnosis because you do not have access to the testing and imaging available in a hospital. The real problem came with the second visit. The GP practice’s own protocols set out conditions which Physician Associates could and could not see. If the document had been adhered to then Emily would not have seen the Physician Associate, at least on the second occasion. For some reason this procedure was not followed. This was not the fault of the PA.

Misdiagnosis happens all the time – PA, Drs, ACPs, everyone does it all time time. When there is a failure it is always a system failure, it is a series of event which lead to the problem. Except in cases of criminality like Harold Shipman, finding individuals responsible is not good practice – it is about looking at how the system failed. Every doctor knows this. The BMA knows this.

PAs are being judged to a different standard

https://news.stv.tv/west-central/ayrshire-patient-died-from-dangerous-blood-clot-after-being-misdiagnosed-by-gp-with-anxiety

This link is to a news article with an almost identical case. A young woman seen by a GP DOCTOR, diagnosed with anxiety and subsequently died of a Pulmonary Embolus. The GP surgery was ordered to apologise. The GP kept their job and the surgery still employs doctors. Physician Associates are being held to a different, and far higher standard, than doctors.

This is not an isolated incident, roughly 310 fatal pulmonary embolae are missed by doctors every year, almost one a day. It is so common it is not newsworthy, but one fatality associated with a PA is newsworthy because it is so incredibly rare. My own friend Lucy died of a PE last year, she had been seen by her GP doctor twice and incorrectly treated for a pneumonia – she did not even make the local news.

Emily Chesterton’s death is being exploited by the BMA

What is truly horrifying is that the parents of Emily Chesterton are being exploited by the BMA for their own political ends. Grief is a process we go through, part of that process is getting angry, looking for answers, endlessly asking the what ifs. The BMA has exploited this by using Emily Chesterton as a reason to get rid of Physician Associates. They even funded Emily’s family taking the GMC to court. – a process that put more stress and upset onto an already grieving family. The BMA is perpetuating the grief of Emily’s family.

Emily Chesterton’s death is emotionally powerful because she is a beautiful, young woman who died with all her life ahead of her and failed by the health service she went to for help. Her death is not a reason to get rid of Physician Associates – just as Lucy’s death and the other 310 people who will die this year of PEs misdiagnosed by Doctors are not a reason to get rid of Doctors. Emily’s death is a reason to look at the system and ask what went wrong and how it can be improved so we can avoid another Emily Chesterton in the future – getting rid of PAs will only make that situation worse because it simply puts more work onto GPs who are already at breaking point.

ADDENDUM:

What about Jess Brady?

https://www.bbc.co.uk/news/articles/cly0428jjpeo

Jess Brady had over 20 consultations with different doctors at her GP surgery only to end up going private and discovering she had a cancer which was too far gone to treat. This is despite information in some of the blood tests that Jess had had indicating that something more serious was going on. This is system failure far worse than that of Emily Chesterton because Jess saw multiple GP Doctors on multiple occasions. What is very interesting is the Royal College of GP’s response is to view this is an educational and training opportunity. This is a very different response to Emily Chesterton’s case which was to dismiss the PA and never employ another PA ever again. PAs have to work to a far higher standard than doctors.

What about Cameron Lamb?

https://www.dailymail.co.uk/news/article-15187383/Hospital-worker-dies-colleagues-misdiagnose-condition-send-home-antibiotics.html

This poor healthcare assistant went to the hospital where he worked and multiple doctors examined him, they concluded he was dehydrated and sent him home where he died of a pulmonary embolism. Meanwhile the Trust concerned has “shared his case with colleagues to highlight the difficulty in diagnosing a pulmonary embolism when patients have non-specific symptoms.” No one has lost their job, no one is saying that a whole staff group should be sacked. A bit more thought and a simple blood test and this death could have been easily avoided.