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 used to manage NHS complaints
I can well believe it happened unfortunately. Most staff are professional and communicate well but there are the occasional few who don’t

My advice would be to write to the trust, copying in the chief exec. Ask them to investigate it formally. Name people if you can or describe them, even if they deny any wrongdoing they will still be spoken to by their clinical supervisor as a doctor in training. It will also be recorded so if there is a pattern of a number of complaints around communication issues it will be investigated further and may become a training issue for them (I have seen this happen before on more than one occasion).
Just to add, the hospitals take communication and feedback far more seriously than they used to even 10 years ago. CQC will look for evidence of good communication if they come in to inspect
Good luck and I hope you get a reasonable outcome

I think you should make a complaint, I think you were treated disgracefully. Unfortunately making a complaints is often the only way that things change. Personally I have only had positive responses from PALS, but you can escalate the issue if they do not help. Good luck!

Glad I’m not the only one who can see this @Todaythiscouldbe. As I said, I hope she wasn’t as unpleasant as this on the day.

Even if it was all related to anxiety, that is still a poor way to treat someone

I find the "Dr Google" admonishment bandied around a bit frustrating, although I appreciate there will be many who can't evaluate sources or context when reading about conditions. Health professionals do have the contextual understanding and experience that adds colour to a clinical picture but will not know everything about every condition at the drop of a hat.

I also don't agree with spurious complaints to an overburdened NHS, but do agree with feedback in situations like this when the OP has been confused with another patient and this could have influenced her treatment - as well as being very rude to OP.

I'm another who had "Dr Googled" my daughter's condition, we were pretty sure we knew what it was as even though it is very rare it presented exactly in that way and we could not find many other things that would result in the same. Our GP was brilliant and he agreed, but every paediatrician we saw at the NHS laughed at me and said "first baby?" and that there was nothing wrong. I even paid for a private consultation and was told the same. Also paid for private therapy and they were clearly humouring me and taking money for what they thought was nothing until one day they said "does she always do that? And that?" and I told them yes, that was what I had been trying to tell everyone. All of a sudden loads of phone calls were being made and I was being spoken to carefully and patronisingly as if I were unaware that my daughter had a specific condition even though it was the same condition we were fairly certain she had all along. Even then the next paediatrician along dismissed us until we paid again to be seen at one of the big children's hospitals privately and they agreed too (after starting the appointment with "why are you here?") and finally the whole process was kickstarted and we then had loads of NHS appointments and still do (and probably will for some time)

In our case confirmation involved diagnostic imaging and I completely understand why this is avoided in small children unnecessarily, but it would have been one thing to be told that we might be right but it would be best to wait for a while to see what happens, whereas instead I was more or less told to stop being neurotic. As it happens it's being treated urgently now as well.

I haven't complained because I don't think in our situation it would have been useful, but it was very frustrating.

Unfortunately, intelligence, education and a professional title are no barrier to the uglier side of human nature. You see it in other professions , too - from the bullying teacher to the crooked lawyer. In the scheme of things, no real harm has been done but there is potential there with the next patient who is not taken seriously and lacks the assertiveness that you have to follow it up.

Dear oh dear, I'm seeing this more and more in the NHS now, I have worked in the NHS for 35 years.
People who have zero people skills whatsoever and give you a telling off for doing something you not only thought was correct but that 111 told you to do. I'd be very annoyed indeed if "neurotic" was on my notes because it implies crying wolf rather than taking symptoms seriously and that could affect your future care.
I caught one of my lot doing it the other day - a patient was told to come in if they was any change in his condition or his wound reopened and one of our own staff told him he was being ridiculous and to stop wasting our time.
He could have had sepsis and should never have been ridiculed.
I would definitely report to PALS.

Some nurses do have PhD or professional doctorate qualifications, so could introduce themselves as Dr.
It sounds unlikely though given the way you were treated by this person.
Incidentally, did they check your temporomadibular (jaw) joint? Sometimes dysfunction of this joint can cause the spasms you describe.

MrsDrudge they did have a feel of my jaw, open and closed, several times. My lower front jaw/teeth are sore again today and my chin was twitching for a while. They said to ignore twitching and only come back if my face/jaw goes into spasm and doesn’t unlock (as it were). I’m pretty sure twitching is spasm, though it only lasted about 10 seconds. Such strange symptoms. I wonder if I’m clenching in my sleep and it’s causing all of this, but it’s nothing I have every experienced before.

@WhatTheSock that’s reassuring. I think you could be right, clenching or grinding your teeth during sleep could cause it.
No excuse for how you were treated though in such a frightening situation. I agree you should pursue it, contact PALs and ask for formal complaints procedure and if no joy write direct to director of clinical care or CEO.

I have TMD from bruxism caused by my teeth not aligning properly due to braces when I was younger.

I'd be surprised if it was TMD because that tends to be a gradual thing, not waking up one day with a locked jaw. So have you had any symptoms before this point? Like a clicking sound in your ear, headaches on one side, tenderness in front of your ear where the jaw joint is?

WorksTheDinerAllDay I had migraine pain (right sided mainly) for at least a week, intense behind my eye for one day, and radiating into my top right teeth. No tenderness in front of either ear but today I have weird noises in my left ear when I chew.

Lot of head pressure today too.

Having your jaw lock shut with TMD is extreme, as it means your masseter muscles have reached their limit. However I don’t think many people notice the earlier signs.

Eg waking up with jaw pain could be attributed to sleeping awkwardly, or just unremarkable as the pain tends to subside as the day goes on, so not something a person might dwell on as a sign of anything untoward. Headaches can be attributed to normal life stresses, difficulty eating chewy food could be blamed on the food itself rather than muscle fatigue etc

What do you want from complaining? What outcomes are you after? You’re well. You were seen and assessed. They laughed a bit at what may well have been an overreaction from Dr Google self assessment. Hardly life changing. The NHS is under huge pressures at the moment and it’s unclear what complaining will achieve

@CherryPavlova if OP were me I'd want the staff to be reminded of the NHS core values, something they'd committed to follow when they signed up, so hopefully they behave better in future

The NHS aspires to the highest standards of excellence and professionalism
It provides high quality care that is safe, effective and focused on patient experience...Respect, dignity, compassion and care should be at the core of how patients and staff are treated...

We ensure that compassion is central to the care we provide and respond with humanity and kindness to each person’s pain, distress, anxiety or need

Respect and dignity
We value every person...We take what others have to say seriously...

Commitment to quality of care
We earn the trust placed in us by insisting on quality and striving to get the basics of quality of care – safety, effectiveness and patient experience – right every time. We encourage and welcome feedback from patients, families, carers, staff and the public. We use this to improve the care we provide and build on our successes

So, OP is well within her rights to give feedback/complain. As far as I'm concerned behaving in any way which causes the patient to feel dismissed or belittled, such as by laughing at them, eye-rolling, sighing, tutting, etc, has no place in healthcare. Of course staff are occasionally going to get irritated by patients but they need to put their professional face on, follow the NHS 6Cs, then offload privately in the staff room.

The spelling mistakes alone make me wonder about this persons training........

Yes complain. It seems they muddled you up with another patient, but in any case, no one should be patronised and spoken to like that. Anxiety or not.

The only part I wouldn’t be worried about is her removing the scab - pretty standard in assessing the wound.

Also I would complain direct to the trust, not PALs who IME were useless.

It sounds like you were confused with another patient, regardless, even had you been that patient everyone should be treated with respect.

I'm a nurse but as in every walk of life and profession there are people that are rude or incompetent etc etc, the list goes on, nursing is no exception. It is exacerbated by the fact that we have a massive shortage of nurses so even poor quality staff are kept, this is the same in NHS as well as private (more so in private in fact)

I think you most definitely should complain, if they were talking about you being there the week before and ringing the department of tropical medicine, then they most definitely had you confused with someone else and this could have had very serious results if you in fact did have tetanus. I would absolutely not allow them to document anxiety disorder regardless if what the computer will accept

I have just had a telephone consultation with my GP who thinks TMD sounds likely. The pain has moved from my chin along my jaw and into my ear, and the pressure in my head is pretty bad. He suggested ibuprofen and soft food.