To think this should have been picked up sooner?

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DD has been ill the last few days with tonsillitis. She called me yesterday morning at 5 a.m., telling me her tonsils were so swollen she couldn't breathe. She has anxiety, so I assumed it was a panic attack, and she did seem to breathe more easily once she calmed down, but she still maintained her breathing was restricted because of her tonsils, so I directed her to the pharmacist (still believing it was a panic attack/anxiety)

The pharmacist looked in her throat and told her that her tonsils were swollen and that he could see "white stuff," but ultimately, there is nothing that can be done for tonsillitis, so he sent her home with a throat-numbing spray and advice to rest and contact her GP if it got worse.

She came home very distressed, which I still believed was anxiety, but I told her to contact her GP if she was in enough pain that she felt she needed to be seen that day. I heard her on the phone telling them one side of her throat was more swollen than the other side, and it was making her "feel" like she couldn't breathe easily. She also told them she'd not eaten in 48 hours as she couldn't swallow but was managing small sips of liquid with difficulty. She was told there were no appointments and nothing could be done for tonsillitis, so try to rest, drink plenty of fluids, and call 111 if it gets worse.

She tried 111 immediately but kept getting directed to a voice message giving her details on how to find an emergency NHS dentist. She was in too much pain to keep trying, so she put the phone down and went to bed in tears. I did manage to get through on 111 on her behalf, who also said it was tonsillitis and to rest/drink fluids, but to call back if it got worse.

The second I finished work, she was up begging me to take her to the walk-in center. I did, but at this point, not being a medical professional, I still thought it was tonsillitis and anxiety.

As soon as she was seen, they told us to go to A and E immediately and to call 999 if she felt like the swelling was worsening on the way there. The on-call ENT specialist was called out to meet us there.

It turns out she had an abscess on her tonsil, which is very serious because it can worsen rapidly and prevent breathing. People have died from not getting treatment quickly enough, apparently.

AIBU to think this should have been picked up by the pharmacist, the GP, and the 111 algorithm? The main warning sign is one tonsil being significantly more swollen than the other, which she told all three services, along with trouble breathing and swallowing.

I realise I didn't help by dismissing it as anxiety, but I am not a medical professional and wasn't aware that tonsil abscesses were a thing, let alone a potentially life-threatening thing.

There are two lessons from this:

1. The NHS cannot distinguish mild from severe everyday illnesses and so going to A and E if you are unsure is always justified so don't let them make you feel bad about that
2. Doctors, not pharmacists, triage or anyone, need to see most tonsillitis cases, which are 'more' than just a sore throat, in person.

There's no point in wishing for multi-disciplinary health-care centres with swabbing, scanning and treatment in local areas, that's not happening, it does happen elsewhere. My daughter was taken ill in France last year and had a scan of her lungs, swabs, seen a proper doctor in person and the correct antibiotics within about 4 hours in a local clinic there.

We are so used to this we blame the patient!

I’m a doctor and this is shocking. Quinsy is a recognised complication of bacterial tonsillitis. Your daughter was describing the absolute classic presentation. I’m convinced a qualified GP would have sent directly to A&E if they’d seen her in person.

this is a huge issue in medicine - patients are being increasingly directed away from doctors and towards “allied health professionals” (pharmacists, PAs, ACPs). They claim to only see “simple” diagnoses but it’s impossible to say what’s simple until it has been seen by a doctor. This simple case of “sore throat” was actually a life threatening emergency. Everyone should insist on being seen by a doctor, and this is what I do for my family.

Pharmacists are not medically trained to diagnose. (Although my local pharmacy can give antibiotics for tonsillitis and a few other things) I do find it strange how she was told nothing to be done.

She didn’t see a GP, it’s not their fault they had no appointments.

My guess is you are mad at yourself for being so dismissive, when she was really ill, and you are trying to offset that guilt.

It happened. She is fine. Forgive yourself.

It's easy to criticise the pharmacist but unless anyone actually assessed OPs daughter at the time we don't know if there was any evidence of an abscess, how swollen the DDs throat actually was at that point or how she presented.

Most tonsillitis does not require antibiotics. White spots doesn't mean it needs antibiotics. Someone having pain on swallowing doesn't mean a quinsy, and someone saying they feel like they can't breathe doesn't necessarily mean a quinsy if there's no evidence of swelling or no actual evidence their airway is at risk or they are struggling to breathe

The fact it was drained and OPs daughter sent home suggests her airway was not compromised, her feeling like she couldn't breathe could just have been anxiety. Whilst yes a spreading tonsillar abscess can be life threatening, most are not and are easily treatable

The key takeaway point is if you physically can't swallow or can't breathe go to a&e

You are getting a really hard time here, OP. They should absolutely have spotted quinsy.

Quite honestly, I’d stop looking for someone to blame and focus on how you can change in future towards your dd. You dismissed your dd immediately. She told you how bad she was, but you dismissed her. I can only imagine when the pharmacist looked, both tonsils were the same size, maybe only a few white spots? Not all tonsilitis with white spots is treated with antibiotics, I’ve not idea if there has to be a certain coverage, certain degree of spots? The pharmacist did advise to contact GP if it worsened. At the GP, your dd presumably spoke to a receptionist, who let’s face it, won’t be qualified to diagnose anything. But from here it seems both your dd and yourself knew one tonsil was now bigger than the other .. but neither of you googled this? 🤔 Did you even look in your dd’s mouth? Did you even believe her when she said she was struggling to breathe? Were you not concerned that she could barely sip water?

A similar story has been in the news this week after an inquest regarding a young man who died from having a Quincy. Apparently there was no inclusion of this risk in the 999 algorithm https://www.gazettelive.co.uk/news/teesside-news/andrew-watson-quincy-ambulance-inquest-34140346.amp

As a pharmacist myself who operates under the pharmacy first scheme all I can say is if it was me I would have referred her to A+E immediately. With out training we are taught to look for signs for quinsy, epiglottis, diptheria etc. Unfortunately with every profession you are going to get poor professionals. I had a patient come in after seeing a doctor the same day that came in with shingles on the side of the nose (dr thought it was bacterial so prescribed her some cream) and sent her to A+E immediately. I potentially saved that persons vision. So please don’t tar us all with the same brush like you wouldn’t with doctors in this case.
Therefore I do really think OP should put in a complaint about the pharmacist.

This with knobs on ... my late OH was a GP and simply would not believe what is happening.

The whole point of being medically qualified in this sort of scenario is that a qualified medic will be able to distinguish between something simple and something potentially dangerous.

I once had a call back from a "clinician" following consulting 111. After she gave inappropriate advice I smelt a rat and I asked her if she was a doctor .... she told me she was a physicians associate. She should have told me that at the start I think. And she should not of course have been giving faulty advice.

I do think there is a role for non medics ... some specialist nurses can be invaluable ... e.g. arrhythmia Parkinsons diabetes ... but they offer support and not diagnosis.

How do we stop this slide into life-threatening mediocracy?

Maybe she will realise now that keep shouting she cannot breathe, when she can, means that when she is ill she gets dismissed!

Time for her to grow up!

I think people are picking up on DD saying she felt like she couldn't breathe, which is understandable, but perhaps these posters don't have a lot of experience with severe anxiety. "I feel like I can't breathe/eat/drink." "I'm going to throw up/pass out," and variations thereof are things DD says to me on an almost daily basis. If we went to A and E everytime she felt like she couldn't breathe, we'd literally never be anywhere else.

When she first phoned me, I couldn't see her. I was two hours away from her. She sounded like she could breathe, and what she was saying were things I hear from her frequently but I couldn't see her, so I sent her to a pharmacist to get her tonsils checked out, as we are advised to do constantly.

By the time I saw her in person, she'd seen someone I believed to be a professional who had no concerns about the swelling in the throat preventing her from breathing.

I've just spoken to DD2, who was with her yesterday, and she said it was a big city center Boots they went to, so I would assume they had a prescribing pharmacist on site. The pharmacist did look in her throat with a light but said it was tonsillitis and probably viral, so the advice was to rest. DD2 felt they were being fobbed off, so she tried to argue that DD had been ill for days and was getting worse, not better, but they weren't listened to. She then asked if they could at least give them stronger painkillers, but the pharmacist said he couldn't prescribe anything because they'd told him DD1 had already taken paracetamol and ibuprofen.

DD2 then tried to buy over-the-counter co-cocodamol, but they refused to sell it to them because of the paracetamol and ibuprofen she'd already taken, which, in fairness, I agree with. IDK if pharmacists can see medical notes, but DD has a history of overdosing on painkillers, so not selling her more seems sensible to me.

They tried our regular pharmacist on their way home, but were told the main pharmacist who could diagnose/prescribe was on his lunch, so they asked them to come back in 15 minutes. However, by then DD had spoken to a nurse practitioner at our GP, who told her the same thing as Boots, so she never bothered going back.

How old is your dd?

Doctors go through years and years of training where they see multiple presentations of different illnesses over and over, which eventually gives them the background knowledge to know what constitutes a red flag or not. A huge part of their training is presenting cases to superiors who then point out the subtle differences between presentations and the things they could have missed. Pharamacists are fantastic and have an absolutely vital role in healthcare but they are not trained to the level required to be able to make the distinction between subtly different presentations. Lack of experience is the huge problem here - if you have never seen quinsy and you don't regularly look into throats, review cases, discuss diagnoses with colleagues, then the chances that you will remember details from your training are not high enough to take the risk.

What I'm wondering - and you may know - is whether certain pharmacists, having recognised the risks, or having experienced near misses, are now passively resisting making decisions and refusing to say anything definitive to patients? I could see that happening quite a lot, where the risk seems to high so some pharmacists, while purporting to take part in pharmacy first are in fact only doing the bare minimum, ie providing advice around hayfever and colds and such.

Deciding whether something is serious or not is the riskiest part of medicine. It is beyond crazy to give that task to people with the least amount of medical training.

I'm sorry OP but I can't believe you continued to dismiss your daughter being so ill once the Pharmacist confirmed she did indeed have tonsillitis. It takes 60 seconds to look at the NHS page to confirm how serious tonsillitis can be, she very obviously needed antibiotics. I don't understand how you just continued to be so dismissive.

No I don't think this is on anyone else. If I was actually struggling to breath I wouldn't go to a pharmacist or get on a train. I'd go to a and e. And doctors consider your behaviour in assessing how serious something is. Lots of people say they can't breath, while breathing perfectly fine. She clearly did have tonsillitis. And considering the abscess can grow rapidly she might well not have had it when she went to the pharmacist. The advise given was correct. You don't get antibiotics for tonsillitis usually as it's viral.

Considering she lives with you did you not for a second think to have a look yourself? Then you could have told 111 it looks like she has an abscess on one of her tonsils.

Moral of the story, if you feel like your own body is suffocating you, go to hospital.

I assumed that if she was ill enough to need antibiotics, the medically trained pharmacist would have given her antibiotics or triaged her to AandE/Urgent Care if he wasn't able to. That is why I told her to go there as per the guidance we are given.

Tonsillitis doesn't always need antibiotics.

Well what are people supposed to do? Doctors dismiss you and won’t even see you in person, most of the practice nurses I have dealt with have been vile to the point of stopping me engaging with them.

You are quite dismissive of pharmacists, aren’t you?

I’ve had a few friends and colleagues with quinsy and they’ve all had similar. I think it can present like tonsillitis but keeps getting worse as the bacteria increases. I hope she’s well again soon

No.

You’re getting a tough time OP. You’re not a medical professional and you directed her to appropriate advice from three sources: pharmacy, 111 and GP. Having been told by all three to go home and rest, I don’t think you were unreasonable and I do think that someone in that chain should have suggested the possibility of it being more serious. A trained pharmacist looked in her mouth and I’m not sure what the poster who suggested that you should have looked thinks you could have diagnosed better than a trained professional. You did what we are told to do by the NHS and they let you down.

I accompanied my adult DS to the GP a few years ago. He was complaining of a sore throat. He actually had an infection on his uvula, the nurse practitioner was horrified. He showed me, and it looked awful. A course of antibiotics cleared it up smartish but I was told monitor his breathing as it can worsen and cause a choking feeling or breathing difficulties. Since then, I take sore throat very seriously.

Really? Your posts would suggest otherwise.

If someone is ill and they can’t see a doctor but it may not be bad enough for sitting in a&E for 12+ hours (and even then find that the doctor hasn’t bothered sending any information to the GP) - what’s the alternative?

111 just tells you to go to A&E.

The fact that the system is shit doesn't mean that sending people to the pharmacist is the right answer.

We were directed to a pharmacist today for tonsillitis and I have to say the service was actually really good. They have to meet certain markers or criteria for bacterial tonsillitis ours was temp of 39 which wasn’t going down with usual pain relief, examination of tonsils which are enlarged anyway had stones and white puss. Unfortunately tonsillitis is so common and 9/10 times is self treating gargling with salt water and other pain meds. I am sure if your dd was as bad as you say then first stop would have been urgent care not GP or 111. Completely understand the need to question the care received but sounds as if everyone involved or triaged did exactly as they are supposed to do.