To complain to PALS

[WhatTheSock]

This is a weird and long story and I really am not sure whether to make something of it or not.

Had a deep puncture wound with dirt stuck in it a couple of weeks ago. Went to get it cleaned out and patched up at a walk-in clinic. Was asked if tetanus boosters were up to date. They weren’t as I have terrible reactions. They sent me home saying if there was any sign of infection to come back. It healed up well after some initial swelling and pain but I thought nothing more of it...until yesterday morning when I woke up with my jaw in spasm! It only lasted a few seconds but enough to terrify me into thinking I had tetanus. I called 111 for advice and they told me to get to A&E ASAP.
Off I went. I was triaged and sent to a lady who introduced herself as Dr so and so, and then proceeded to tell me I had an “anxiety disorder”. I explained that I had a tetanus prone wound two weeks ago and that my jaw was in spasm when I woke up and she told me there was “no way” I had tetanus as it would have developed within 3 days and I wouldn’t be sitting there talking to her. I explained that I had read the NHS info on tetanus and it said 3 to 21 days for it to develop. She said “You seem to know a lot about tetanus” with a smirk. So then she starts phoning someone and asks if they need to see me, whilst chuckling to herself.. and then types “anxiety disorder” into the screen. I questioned this again and she claimed the computer wouldn’t accept “suspected tetanus” and she could ONLY put anxiety disorder. Next thing she does is examine the wound itself, and she started trying to pick off the scab! I asked her to stop it and she laughed and said “I’m just having a look at it!” and then she disappeared out the curtain and started discussing me with someone else whilst again laughing. She then phoned someone else to discuss me but this person asked her to send me to an emergency assessment unit. So I went there and was met eventually by a junior doctor who greeted me with “So I’m told you were here two weeks ago with a similar condition and you got us to phone the London School of Hygiene and Tropical Medicine?”

WTF?!!

I had never ever set foot in the place! I felt like I was in the Twilight Zone!
They tried to find me on their system but obviously didn’t, as I had never been there before. They asked me about 15 questions and wrote down my answers. Then I was passed to someone else who asked me the same 15 questions and then disappeared. Then a nurse came in and asked me another load of similar questions...and then did a heap of blood tests and an ECG! They then asked me to sit in a waiting room. I was there from 8am until 6pm (along with some poor souls who were groaning in agony with various ailments) and then eventually the second guy came back and said I could go, because I’d had no further spasms, but if I had any other signs of tetanus to come straight back to A&E. He gave me the discharge form and I put it in my bag. As I was leaving he caught up with me and handed me another dis barge form and asked for the first one back. He’d changed “Initial diagnosis: Spasm in jaw” to “Initial diagnosis: anxious twitch in jaw”!!

I left.

I have been trying to process it and understand what on Earth happened. I don’t know whether to make a complaint to PALS or not. How do I even explain it all? Surely a case of mistaken identity? But to be so rude and unprofessional, trying to pick off my scab as if I’d stuck a fake one on... Laughing at me, claiming I had an anxiety disorder....

AIBU to make a complaint? It sounds so far fetched yet it actually happened!!

I doubt very much she thought you had a fake stuck on scab.

She was probably assessing the wound and seeing if the scab would lift and had a collection of infection underneath. Scabs aren’t a good thing in wound terms.

Tetanus was a very unlikely diagnosis, I don’t believe we’ve had any cases in the UK for donkeys years. If you’ve had your childhood immunisations then you’ve had enough tetanus vaccine for a lifetime. The original wound may not have been a tetanus prone wound or they would have insisted on giving you a booster and monitored you for side effects (what sort of reactions do you have?). It’s actually quite unusual to see tetanus prone wounds even puncture nail wounds etc. Infection is far more of a risk.

I can tell you’re distressed by this so you may find it helpful to write a letter of complaint but be prepared for little to no outcome from it.

Thanks Sidge. I have never had a tetanus jab (as far as I know) and I’m nearly 50. I had a life threatening reaction to a vaccine (my only ever vax) in childhood. In an unvaccinated person any dirty puncture wound is a tetanus risk, although it did bleed which I believe lowers the risk. It was hard to tell how deep it went as it was through my shoe as well.
If tetanus prone wounds are so rare why is everyone offered a booster for every cut/graze? My child was offered one for a very superficial scratch.

A tetanus booster itself is not the correct course of action if tetanus is suspected. It needs the tetanus immunoglobulin instead.

Complain to the trust directly. Stick to the facts. Don't embellish. Talk about how you were made to feel, patients are supposed to be treated with dignity and respect and listened to. Ask for staff to be better trained and ask about their systems - they should not have mixed you up with anyone else. I've had a similar issues in the past with nurses assuming things and not listening to me / my story and being quick to refer for 'anxiety' rather than the actual medical issue. Luckily consultants over-ruled and realised there was actually a medical issue to be dealt with

I doubt very much she thought you had a fake stuck on scab.

She grabbed my foot and dug her nail into the scab! Her hand was gloves but it was very unexpected and was quite painful! She wasn’t seeing if it would lift..she was actively trying to dig it off with her nail.

Definitely complain. DP has anxiety disorder and if he's ever in A+E for something unrelated to his anxiety, they say it's probably anxiety making him "think he has those symptoms" or tell him to speak to his GP about his anxiety.

He once went to the walk in centre for tonsillitis as GP had no appointments and sent him there and they said they couldn't see white spots and it was probably his anxiety making him think there's something wrong.

@WhatTheSock

A tetanus booster itself is not the correct course of action if tetanus is suspected. It needs the tetanus immunoglobulin instead.

I know. I was referring to the action when you originally presented with a wound.

I would also encourage you to start a primary course of vaccines once you’ve established what vaccine you reacted to. If you can ask parents or check your historic medical records it would be useful.

Some children historically reacted to pertussis vaccine when wholecell vaccine was used, it would have been worth knowing if it was that as you wouldn’t need that now.

Wouldn’t need pertussis I mean; we don’t use wholecell pertussis vaccine anyway.

And your child shouldn’t have been offered a tetanus booster for a scratch, unless it was an opportunistic booster which was due anyway.

Tetanus prone wounds are usually deep, dirty or devitalised.

Sidge I know which vaccine it was, and my medical notes had “DO NOT VACCINATE THIS CHILD” all over them from then on.

Complain, complain, complain. And don't stop complaining until you get an apology.

I'm another one who has had a genuine medical condition repeatedly diagnosed as anxiety until one GP finally took me seriously and referred me to the right specialist.

The NHS has a culture of dismissing women as anxious and if no one complains that will never change.

Which vaccine was it? Just curious.

Oh and guidance has changed in the last 50 years...

On a bit of a side note, have you looked into TMJ based migraines and bruxism OP?
I had all the same symptoms as you - headache, jaw pain, seized jaw, pressure across teeth / cheeks / eyes. Might be worth looking into.

I don't for one second find it hard to believe OP was dismissed by the person in triage. I've encountered people in hospitals before with the absolute worst patient care that it beggars belief they'd even work in that profession.

I broke my ankle badly a few months ago, whilst in triage two women who were meant to be looking over me instead spent 20 mins (in a closed off room, 3 feet away from me, never acknowledged me in the slightest) with one absolutely crying her eyes out over having to cancel her daughters ballet class because of money issues, whilst the other one then started slagging off one of the porters about how incompetent he was. Not once did they both speak to me, look at me, interact with me in any way. Said 'incompetent' Porter then came to take me elsewhere after a while, crying nurse had mascara all down her face and gave me a vile look on the way out (still not said a word to me). Honestly blew my mind it was such a surreal experience.

I know 99.9% of NHS workers are angels, but it really it that 0.1% of bad eggs which leave the strongest lasting impression.

I'd complain if I were you OP.

Are you a medical professional OP? Some of your posts could come across as patronising, almost like you know more than the staff treating you. It does seem highly unlikely for you to have developed tetanus, which would play into their “health anxiety” angle. This is something you should tone down in your complaint as to not give the wrong impression.

Your jaw being locked shut could even be TMD - especially as it was after you woke up (after a night of clenching and overwhelming the masseter muscles perhaps). The headaches and teeth pain could also be signs of TMD, even the cheek pain if it’s nearer your temples.

So why didn't the health professionals maybe suggest TMD if they felt it was not Tetanus related, rather than blithely dismissing it as anxiety?

MooshWoosh I am wondering this now, though some of the pain is in my front lower teeth (been checked by dentist and no issues with those teeth). It is/was very coincidental though to suddenly develop TMD two weeks after stepping on a nail, with no previous history of jaw issues.

Frappuccinofan

Are you a medical professional OP? Some of your posts could come across as patronising, almost like you know more than the staff treating you

I am not a medical professional but I am able to read. Tetanus usually occurs between 3 and 21 days after the initial wound according to just about every document (including NHS) that I have read on the subject, so am I supposed to ignore all that and accept a mocking nurse telling me it would have happened by day 3 and I would have already been dead by now (15 days after the injury) just because she is a “health professional”?

Bloody hell, you’re nasty OP. She isn’t a “health professional”, she is a health professional. I hope this wasn’t your attitude on the day.

Eh? I was quoting “health professional” in the sense that she is supposed to be one whilst I am not. I think you are misinterpreting what I wrote.

As in, being a “health professional” doesn’t make her an expert in every aspect of health.

What’s “nasty” about that?

I work in the NHS and I’ve had some good and some very poor treatment as a patient as well, I’ve been laughed at by a doctor, then had my prescription thrown at me and told to leave because I dared to politely question something he said about a medication I was taking, so I can believe it happens. The NHS is like any workplace, there are good staff and there are staff so bad you wonder how on earth they’ve kept their jobs there. Please do complain, I wish I would have complained about the GP who was vile to me (who incidentally told me he had worked in Nigeria as well).

@WhatTheSock

Eh? I was quoting “health professional” in the sense that she is supposed to be one whilst I am not. I think you are misinterpreting what I wrote.

She's not supposed to be a health professional, she is one. Can you really not see how this is coming across?