July 12th, 2017

You Might Be an American Physician Assistant in the U.K. if …

Megan Tetlow, PA-C

Megan Tetlow, PA-C, is from Fort Myers, Florida, now working in Sheffield, England, as part of the National Physician Associate Expansion Program.

Somewhere between figuring out what foods classify as puddings* and learning how to make the physician assistant (PA) role work within the National Health Service, my colleagues and I find that we have arrived at our 1-year anniversary of working in the U.K. As I reflect on both the successes and struggles of adapting to life here, my overall thought is how far we’ve come and how much we’ve grown, both professionally and personally. I would like to look back at some of my own growing pains with a segment I’ll call:

“You might be an American PA in the U.K. if …”

  1. … you never call anyone by the correct title.

Megan, Miss Fiona Kew & the robotic surgery team

I had heard before coming to the U.K. that (male) surgeons historically styled themselves as “Mr.” and not “Dr.” The use of this title dates back to the 1700s and earlier, when surgeons wielded a knife but did not necessarily have formal medical training in the form of an M.D. Fast forward many years, and surgeons are M.D.s and are admitted into the Royal College of Physicians, but they’ve kept the “Mr.” title as a point of professional pride. Knowing this, I was still surprised by the array of titles. For example, I work for four surgeons in the gynecologic oncology department. They are professionally titled, “Mr.,” “Dr.,” “Miss,” and “Professor.” “Miss” does not indicate marital status. “Dr.” can also be a surgeon. I am still not completely clear how the “Professor” title works. Beyond doctors, head nurses are “Sisters” and the senior head nurse is titled “Matron.” These titles do not indicate gender. While I’m on the topic of titles, the CEO of my hospital has been knighted and therefore is a “Sir.” I had the pleasure of meeting him, and he introduced himself by his first name, which I respectfully ignored in favor of saying “Sir Andrew” — because how many times does an American girl meet a knight?

  1. … menial tasks all of a sudden are incomprehensibly difficult.

Like opening doors. One of three buttons needs to be pressed before you can open it. Pro tip — it’s not the green one. That is an emergency switch. I may or may not be speaking from experience. I’m also remembering my first attempt at dialing a number on a U.K. telephone. “Do I just type these numbers?” I asked. “Like, all of them??” My mobile number has 11 digits, 13 with the country code. “Is that a busy signal or is it off the hook?” And you’ll need either a manual or an incredibly patient work colleague the first time you have to bleep (that is, page) someone.

  1. … you are suddenly a terrible speller.

I knew that in the U.K., some words were spelled with an added “u” that we don’t use in the states — colour, favourite, humour, etc. I was not prepared for all the other added letters. For instance, the “o”s — oestrogen, oesophagus, diarrhoea (the “o”s are silent, by the way), and the “a”s — gynaecology, orthopaedics, anaemia (“a”s also silent). Then there are the “s”s instead of “z”s — modernise, realise, organisation. Maths is plural. Sport is not. Probably easier to just accept that you are going to confuse all of these and often use American spellings in British patient charts, and British spellings when you email American friends, and everyone is going to think you are a really bad speller. Which now you are. Welcome to life as an expat healthcare provider.

*Answer: Puddings = desserts, in general. Except if you are talking about a Yorkshire pudding, which is a type of puffed pastry served with Sunday roast. Or if you are talking about black pudding, which is blood sausage that is usually served with a Full English breakfast. None of which are American pudding.



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9 Responses to “You Might Be an American Physician Assistant in the U.K. if …”

  1. Cathy Ruck says:

    Wonderful post!
    You’re living the good life!
    Enjoy it all!

  2. Laura says:

    You also attribute the wrong degree. M.D. Is a one year post graduate degree in the UK and very few medical doctors have one. Instead they have MBBS, MBChB or similar

  3. David Matheson says:

    USA and U.K.: two countries separated by a common language (GB Shaw)

    Here in the UK, only female head nurses are called “sister” but back in the day general nurses were almost exclusively female and an uncle of mine trained as a nurse and later rose to grade of sister and so became Sister Christie from then on. He smoked and had a rather deep voice and apparently caused a lot of confusion when he answered the phone and identified himself by his title.
    In psychiatric nursing, there was no such issue as men were widely represented and titles reflected gender.

  4. Oscar says:

    I think you mean “Royal College of Surgeons…!” I can’t think of many physicians (in the non-Northern American sense of the word, in the U.K., or abroad, who would style themselves as “Mr!”

  5. Víctor Lipovetzky says:

    “English breakfast” could be served in the morning, afternoon and night. Not to be confused with “English breakfast”, a kind of tea.
    All over the day, it should include a vaucher for a coronary angioplasty.
    Nevertheless, lunch and dinner, and “breakfast”, without added nationality or country, are served in the proper times.
    Five O’clock tea is better taken at four o’clock.

    • David Matheson says:

      The observant may notice the strong resemblance between the artery-filling wonders of the ‘Full’ English breakfast and its Scottish counterpart. There are however subtle differences as the Scottish version may also (sadly, rarely) include tattie scones, traditionally made with lard, just in case there is any space left in the arteries. Even rarer than tattie scones in the ‘Full’ Scottish breakfast is haggis, even the vegetarian variety

      Five o’clock tea is largely unknown nowadays but a good afternoon tea (which may include coffee instead of tea) can be worth the seeking out.

      One thing you will find largely absent from your diet is high fructose corn syrup. We Brits are content to rot our teeth with sugar instead.

  6. Krista Gorman says:

    Thanks for sharing your experiences. I’d love to learn more as I’ve considered going over myself. My fiancé lives near Manchester and him coming here vs me going there is not yet set in stone ;). I live in Venice FL by the way!

  7. JM Williams says:

    Really enjoyed reading your blog post, Megan. Several good chuckles. Reminded me of my time in England a few decades ago on a work exchange and as a PA student – i did Family Med and Psych rotations in the West Midlands (Stafford). At the AAPA Conf in May I met, and have remained in contact with, reps from the UK recruiting PA’s for the NHS PA expansion plan. Do you have any recommendations on how i could speak in more depth with other US PA’s who are working with the program? I’d like to know more about the transition you and others have experienced. As Cathy said, enjoy it all! Best to you, Jeff.

    • Megan Tetlow says:

      Hi Jeff, best way might be to contact Dr Jenkins on Twitter @DrNickJenkins. You can also message me on twitter @mltetlow. Thanks for reading!

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