The tragic death of Emily Chesterton, age 30, in November 2022 as the result of the delay in diagnosis of a fatal blood clot has been in the news in recent days.
At the inquest into Emily’s death, the coroner held:
“Emily Chesterton died from a pulmonary embolism, a natural cause of death. She attended her general practitioner surgery on the mornings of 31 October and 7 November 2022 with calf pain and shortness of breath, and was seen by the same physician associate on both occasions. She should have been immediately referred to a hospital emergency unit. If she had been on either occasion, the likelihood is that she would have been treated for pulmonary embolism and would have survived.”
At the end of October 2022, Emily had attended her GP practice with symptoms of calf pain and breathlessness. She was seen by a physician associate who made a diagnosis of a sprain and possible long covid. She was advised to take paracetamol and rest.
Unfortunately, over the following week her condition worsened. Her leg became swollen and she was unable to take more than a few steps before running out of breath. Emily attended the GP practice again regarding her worsening condition and was seen by the same physician associate.
This time, her breathlessness was attributed to anxiety and long covid, and she was prescribed propranolol to treat anxiety. On both occasions, Emily had believed that she had been seen by and received advice from a fully qualified doctor. This was not, in fact, the case.
Sadly, having seen the physician associate for the second time, Emily’s condition deteriorated later that day. She collapsed at home and her partner had to carry out CPR. She was taken by ambulance to the Whittington Hospital, where she later died. An inquest was held into her death.
Emily’s parents later approached their MP, Barbara Keeley, for Worsley and Eccles South, raising concerns that both times Emily had contacted her GP practice for medical advice and treatment, she thought she had been seen by a doctor. She had, in fact, on both occasions, been seen by a physician associate.
What is a physician associate?
According to the NHS website, physician associates are graduates in a bio-science related subject, who have undertaken a further 2-years postgraduate training. They work under the supervision of a doctor, usually in a general practice or emergency medicine environment. Their role involves:
- “taking medical histories from patients
- performing physical examinations
- diagnosing illnesses
- seeing patients with long-term chronic conditions
- performing diagnostic and therapeutic procedures
- analysing test results
- developing management plans
- providing health promotion and disease prevention advice for patients”
Is a physician associate a qualified doctor?
No, a physician associate is not a qualified medical doctor. Physician associates undertake less training than a qualified doctor.
The term ‘physician associate’ is confusing and has come under criticism. The Oxford dictionary defines a physician as “a person qualified to practice medicine, especially one who specializes in diagnosis and medical treatment as distinct from surgery”. The term physician associate therefore implies to many that the individual clinician is a qualified doctor, but of course this is not the case.
Physician associates do have an important role to play with primary and emergency care, however, patients should always be aware whether their treating clinician is a doctor, or not. This issue arises in other contexts too, for example, podiatric surgeons. Podiatric surgeons carry out surgery on feet. They are not, however, qualified doctors. They are podiatrists (formerly known as chiropodists) who have carried out additional training to be able to perform operations. Many patients are unaware that a podiatric surgeon is not a doctor.
Negligent Care and Treatment
From the facts in the public domain, it appears that there were potentially multiple failings in the care and treatment that Emily Chesterton received:
- The physician associate appears not to have properly identified herself or her credentials/role
- The appointments were short and the physician associate did not carry out a full and proper examination
- Not permitting Emily’s partner to accompany her into the consultation room
- Not exploring the potential causes of Emily’s breathlessness properly
- Not documenting the severity of the COVID-19 Emily had suffered a month or so earlier
- Not exploring why Emily felt clammy
- Not taking proper observations including oxygen saturation after exertion or respiratory rate in line with clinical guidelines
- Not referring Emily for an ECG or other investigations
- Failing to recognise the risk of pulmonary embolism (a blood clot on the lung)
- Failing to seek advice from a supervising doctor after seeing a patient who had attended twice within 1 week with significant risk factors
- Sending Emily home without arranging for her to be seen by a doctor.
It is understood that following Emily’s death, the GP practice carried out a serious incident review. They terminated the contract of the physician associate who saw Emily, following concerns regarding the physician associate’s knowledge, ability to recognise an unwell patient and escalate concerns, over confidence and lack of insight in respect of the limitations of her own clinical knowledge and practice. The GP practice apparently decided against employing physician associates in the future, but it is understood that the physician associate involved in Emily’s care is still practicing as a locum in the London area.
The tragic circumstances of Emily’s death have brought the role of physician associate to the public’s attention. Unbelievably, unlike doctors, nurses, midwives, dentists and pharmacists, there is no statutory registration system in place for physician associates. There is a register, however it is currently voluntary. There is an ongoing consultation regarding the regulation of physician associates, and it is expected to be debated and approved by parliament by the end of this year with a view to the General Medical Council becoming the regulator for physician associates from 2024. This is clearly hugely important, particularly given that the NHS reportedly intends to triple the number of physician associates working with the NHS.
You can read more about this tragic case and the parliamentary debate regarding the regulation of physician associates here: Physician Associates – Hansard – UK Parliament
At RHL Solicitors, we understand that no one would wish to begin the long and emotional journey of claiming damages against the medical profession without good cause.
However, it’s crucial to ensure you get the expert legal advice and support you need. RHL Solicitors’s specialist medical negligence solicitors act for the victims of medical negligence, conducting thorough and rigorous clinical negligence investigations with the intention of establishing liability and recovering compensation.
When someone dies as the result of medical negligence, we are also able to act on behalf of the Deceased’s Estate and dependents to bring a claim. The expert reports we disclose to the Defendant during the claim process can also help to make a difference and to improve future care.
If you believe that you or your loved one may have received substandard care as a patient in hospital, causing an injury, contact us on 0344 7768328 to explore a possible claim for compensation on a No Win No Fee Agreement.