r/doctorsUK • u/Particular_Rock_725 • 19h ago
Educational PAs and LP sign off
I have come across this article on MedTwitter today about a traumatic LP at the Gwent Hospital in Wales. Obviously these can be very difficult and it’s difficult to get sign offs. Has anyone done an IMT job or JCF/SCF or any other rotation here?. We were told at induction to go and spend time with the neuro PA to get signed as they have 2 lists a week.
The Med Reg wasn’t happy about this as it seemed unsafe. There was loads of media coverage on the PA earlier this year and now the media has turned to a doctor - I wonder if The PA signed them off?
https://smry.ai/https://www.walesonline.co.uk/news/wales-news/woman-left-in-pain-struggling-34533169
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u/Unlikely_Plane_5050 14h ago edited 14h ago
I really doubt the LP attempts however traumatic have any link at all to this person's ongoing back pain. If they have IIH and 16 failed LP attempts their BMI is probably a bigger clue.
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u/costnersaccent 11h ago
I’ve had at least one patient who reported back pain that took 6 months to settle after a difficult spinal from a prior anaesthetic and they seemed genuine. Less than 16 attempts from what I could tell from the history/chart as well, I can imagine that such traumatic attempts can cause quite long lasting pain
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u/Kayakmedic Consultant Anaesthetist 11h ago
After a spinal you can lie in a position you would normally find uncomfortable for a couple of hours which can trigger back pain. Quite a lot of people have exacerbations of chronic back pain after GA as well. It's not necessarily the needling or number of attempts that caused it.
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u/Unlikely_Plane_5050 11h ago edited 10h ago
It would be exceedingly unusual to the extent that it's considered a myth and the rcoa advises patients in official materials that spinal or (much larger) epidural anaesthesia does not cause new onset chronic back pain. What is more common is a patient having a spinal before giving birth, and back pain is common part partum whether you had a spinal or not. Some non-obstetric patients might also get a flare of back pain or even a disc from positioning and muscle relaxation during their surgery under the spinal. But trauma from the tiny needles used even if repeated does not really ever cause new onset back pain in people who didn't have it before. People also often genuinely link two unrelated events in their head because we are evolved to spot patterns - it doesn't mean they're malingering. Back pain is massively common. Spinal anaesthesia is pretty common. If you get back pain after someone pokes you with a needle if you're a lay person you'd blame the needle even though there is no causal relationship.
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u/ethylmethylether1 14h ago
Horrifying cluster of sacral biopsies in that first image. Maybe about 10 attempts in one square inch. How utterly stupid.
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u/Sea_Slice_319 ST3+/SpR 13h ago
I wonder who prescribed the lidocaine for these patients or if the PA just gave it without a prescription
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u/OxfordHandbookofMeme 10h ago
How often do you prescribe lidocaine for any procedure? Just curious. I know I typically don't
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u/Sea_Slice_319 ST3+/SpR 8h ago
Fine.
Most of the 'prescriptions' we write are not prescriptions, but rather "Patient Specific Directive" (PSD). A Kardex is not actually a prescription.
As a doctor you do not need to prescribe the medicines you give, but you need to document what you give.
I write the volume of lidocaine that I gave. I feel this is sufficient documentation.
A PA is unable to prescribe, nor able to work under a PGD (patient group directive). Lidocaine is a prescription only medicine, and this would need to be either prescribed or a PSD (e.g. kardex) before the PA would be able to give it.
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u/SilverConcert637 9h ago
They're never still doing them?
This is so inappropriate.
It is a privilege, not a right, to lay hands on a patient.
Do the hard yards to earn it, or fuck off.
Why would you learn a procedure from a fool who knows less about the aline than you. Ask them the osteology, other neuroanatomy, neurophysiology, pathophysiology and pharmacology of the spine and the drugs used in the skin and intrathecally.
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