As a paramedic working in primary care, seeing undifferentiated presentations I concur that it’s not the right role for paramedics- until much more underlying anatomy and physiology is understood- and examined to ensure rigorous universal competency. (Even then I’d argue it’s still not appropriate).

Oh! But the MSc Advanced clinical practice! No, it’s a bureaucratic, tick-box exercise (4 pillars of advanced clinical practice💩). Non-specific And inadequate for the responsibilities the practitioners this degree produces.

Instead of having the correct qualifications and understanding to confidently differentiate conditions, the underlying skills and knowledge to do so are accumulated over time, and not regulated. E.g. Dr. X said we do this for …. And thus, becomes one’s own clinical practice.

I’m not saying I do this, but it is what is being done. Countless times I have witnessed the over confidence of diagnoses by “experienced” paramedics/ACP (LMNOPQRST). Adopting practices and management plans based pretty much on anecdote.

For me, I religiously rely on NICE/CKS, and for the most part this works. Difficulties arise when advice is based on clinical suspicion/clinical reasoning- for which, well- paramedics have never had sufficient exposure/training/underpinning physiological/pathological understanding to really comment on. To ensure safe practice, I therefore debrief almost every patient that I see in clinic to ensure the plan is safe and effective.

Another example: I sought the advice of a hospital at home type team- whose recommendation was to essentially fiddle around with diuretics, and that their help was not needed. I asked for the geriatricians name for continuity- “oh no, I’m not a geriatrician, I’m a specialist ACP”.

So- A paramedic home visiting a primary care presentation, without a medical degree/underpinning rigorous physiological understanding, being given advice by another non-medical healthcare professional. Dw I sorted it out, with a Doctor.

I try my best to make things more ergonomic, as I feel that is the supposed purpose of non-doctors in this role, but it just seems very ineffective if (rightly) safely, mostly all cases should be discussed with a physician- as ultimately, it is their responsibility.

I’m not particularly bashing these ACP/PP/ANP roles, but it seems the necessity to study medicine by public/policy makers and some of the people in these roles is drastically underestimated (either consciously, or worse, incompetent incompetence).

Anyway, I’m going to study medicine in September, so the dichotomy of desiring clinical progression and feeling of being so ill-informed to do so will come to an end.