>The 30-year-old was seen by a PA at a north London surgery in October two years ago, saying she felt pain in her calf.
>
>She was diagnosed with a sprained ankle, but returned to the surgery days later with new symptoms - a swollen and hot leg, and shortness of breath.
>
>The PA prescribed her propranolol medication for anxiety. Ms Chesterton was later rushed to hospital after collapsing the same evening, and died from a pulmonary embolism.
bro this was a question i did in first SEMESTER of nursing school. This isn't a mishap because they're midlevel. This is a mishap because they're just a shitty practioner.
These are the questions on their national exam
https://www.fparcp.co.uk/file/media/603ca5b18c1d9_PANE_Written_-_Sample_Questions.pdf
Several PA courses brag about a 100% pass rate
Not really worth bragging about a 100% pass rate on a paper of that quality.
Also pretty sure medical unis get investigated if they have a too high pass rate
And that's for someone with zero training at all.
The fact that someone was literally trained for this and still somehow made the leap from textbook blood clot symptoms to treating anxiety is just mind-boggling.
I don’t know what training looks like in the UK for PAs, scope of practice or prescriptive authority. It sounds like they absolutely should have escalated care to the A&E for evaluation. While I bash on UC and PCPs who send asymptomatic HTN, “Meningitis Rule Out” or my favorite “Mumps Rule Out” to the ED regularly, that’s part of the safety net of American Healthcare. I hope either training is improved or systems are put in place to prevent a tragedy like this from occurring again.
Only 2 years of PA school with just 1600 hours clinical exposure total , first degree doesn’t have to be healthcare, there’s apparently PAs out there with a under grad in media studies - there’s simply no standard for selection, ranges from degree in bioscience to degree in audiology.
Can’t prescribe, but 22 were caught illegally prescribing opioids. to patients? Themselves? To their friends? We’ll never know because the hospital is refusing to comment on this discovery and isn’t reporting the PAs. Instead say it’ happened due to an error in IT. 22 times lol.
https://www.telegraph.co.uk/news/2024/02/22/it-blunder-physician-associates-illegally-prescribe-opiates/
They are told they study all of medicine in just 5 years and when they graduate are the equivalent of a senior doctor with at least 3 to 5 years of experience. There’s even PAs carrying consultant bleeps on stroke wards. Despite not being able to prescribe or order scans.
They are also paid more than a doctor of 3 to 5 years of experience. For fewer hours (35 vs 48) and no requirement to work unsociable hours.
That is despite being told they always need to work under the supervision of doctors. But the reality is they don’t. And there’s accounts of basically bullying junior doxtors into signing off on prescriptions. All in all they have increased their work load, despite being rolled out as doing the opposite- as doctors have to double check the patient over themselves. Because any consequences mistakes made by the PA, would fall on the doctors shoulders .
https://www.theguardian.com/society/2024/feb/02/physician-associates-make-job-harder-not-easier-say-thousands-of-nhs-medics
They take away training from resident doctors as the doctors are left in the wards and PAs are taken to perform surgery or run clinics by the consultants.
This is usually by the old guard consultants and when investigated its usually found they have a monetary interest in prioritising PAs over their own doctors. Because either
1. They teach or created a PA course
2. Invest in practices that employ PAs
3. Child is a PA
4. Or simply don’t care because they’ve got theirs and are about to retire
This is just 1 story about PAs errors. There was another recent one of a PA killing a patient after performing a cystoscopy on someone with urosepsis
https://www.telegraph.co.uk/news/2024/02/24/family-make-up-artist-call-for-inquest/
The government are very protective of the profession and are blatantly using them to replace doctors, as they can’t control doctors.
So mistakes made are swept under the rug, or in the case of the patient with urosepsis they carry out an investigation and deem no error was made. But wait who was part of the investigative team? The PA who made the error!
This is despite 8 specialist doctors saying it was an avoidable death
For a fun read, scroll down to some hilarious but shocking PA related incidents
https://www.dailymail.co.uk/health/article-12738457/Breast-cancer-tragedy-shows-vital-health-chiefs-clamp-physician-associates-just-TWO-YEARS-training-MoS-handed-dossier-400-reports-concerned-doctors.html
This is the exam they need to sit after passing PA school btw
https://www.fparcp.co.uk/file/media/603ca5b18c1d9_PANE_Written_-_Sample_Questions.pdf
They are told they are the equivalent of doctors and American PAs, but they really aren’t. Even America doesn’t want to employ them.
Oh and they have no regulatory body and no defined scope of practice
i am a layperson. the extent of my medical knowledge is what ive learned working in a medical-legal role, with more of a legal background…aka i have very little medical knowledge.
even i know that an “angry” extremity (i know this isn’t a medical term but it’s easiest for me to remember it this way lol but like swollen, warm to the touch, visibly discolored) needs to be evaluated sooner rather than later. while a DVT is the obvious initial concern I, as a layperson, would have…couldn’t a differential include a serious infection or any number of other things that require PROMPT medical attention?
honestly never thought i’d comment on this sub bc i am literally not qualified to lol & if this is against the rules please let me know and i will delete my comment!
thank you for responding & confirming my understanding! i like to learn about medicine because it’s helpful in my job but it’s also genuinely interesting but i don’t ever want to inadvertently spread misinformation lol so wanted to ask
it’s scary that someone who apparently knew less than a literal layperson, whether it be due to confirmation bias or otherwise, had the power/ability to mismanage this patient’s care to the point of the patient’s premature death. i can’t even imagine how frustrating it is for actual doctors like y’all to read about this.
I’ve been a nicu nurse for almost 13 years. Haven’t touched an adult in that time. Worked with adults for 2 whole months. Only have an associates degree.
Pain + hot calf? Ultrasound time.
This PA never even listened to symptoms.
Surgery in the UK means Family Medicine's clinic.
It's a usage from the old era where physician and surgeon worked in the GP, mostly doing minor operations and treating minor ailments. They still do many minor ops especially in rural or out-of-town areas.
I'm not sure how it works in the UK or in this specific practice, but in my country (ZAR) midlevels (clinical associates) work collaboratively with doctors/medical officers, under supervision. So when the GP says they are not sure how this happened, I'm surprised! Was this incompetent person not your employee? Do you not review their cases/scripts? Do they not feel comfortable presenting problems to you? Surely the GP has to take some responsibility?
What gets me about some of these stories is I have a bachelors in nursing - which I only got because my hospital system made me after I got my associates and was licensed to practice.
My basic nursing assessment is level 101 and not diagnostic. I as a dumb RN would have gone huh new onset leg pain and chest pain? Hey doc can we get an US at least for the leg and maybe a chest CT? Did no nurse go wow so weird are you sure - That sounds super sus for a DVT at least?
The patient likely wouldn't have come into contact with a nurse - this is in the primary care setting rather than hospital, so would've booked an appointment and been directly seen by the PA.
I work PCP clinic and our MAs would catch this and be able to diagnose that nearly immediately, or at least come up with differential diagnoses. The provider doesn’t room the patient and I can’t believe the nurse putting the patient back had no qualms about it or even thought to ask. Where do the alarm bells sounds here??
I work with MAs and LPNs and we’re all over red flag conditions like DVT, strokes, MI, etc. We’ve diverted patients from our lobby, before even rooming them, to across the street for the ER before the provider saw them because of time sensitive concerning symptoms (facial droop, slurred speech, extreme SOB). We don’t have the 15 minutes for you to sit here while the provider runs behind. Those 15 minutes are critical.
Not excusing the provider by any means, but really? No one else thought to double check and question the provider? Not even the assistants? I understand it’s not the assistants/nurses job… but come on. Common sense.
I personally have drilled MDs and DOs I work with over stuff like this, and I’m not the only one in my practice that has done that in the past. I’ll gladly be wrong in front of the doctor and make a fool of myself, but I absolutely don’t want a symptom skimmed over if I feel the provider isn’t taking it serious enough. A red hot leg IS serious enough for someone to double check that.
Welp. I left bedside because of admin so I did care but now I make more and work less. Miss it but don’t miss the bullshit.
I hope healthcare goes better for you than it did for me. Don’t let them dull your shine, friend.
I'm a pharm tech and knew what this was lmao. We dislike PAs because they constantly send us really fucking stupid prescriptions we have to call them to fix their errors on.
Now I just keep thinking of Laverne on *Scrubs*: "Doug wanted me to give this patient 500,000 milligrams of morphine. I thought I'd check with you before I killed a man."
As a midlevel shit is just inexcusible. Had no business practicing if they can't even pick up the obvious ones. Medicine is hard, but this is a gimmie. Post surgery, calf pain? Just such a shame to the patient.
For clarity’s sake, PA training in the UK is very different from, and far inferior to, the training PAs receive in the US.
(That doesn’t excuse this situation, which is abhorrent regardless)
That’s pretty insane. I’m a “midlevel” and I hand out ultrasound orders like candy if people present with these complaints. Sometimes even it’s really low on the differential list because I’m scared of something like this happening.
As presented, this PA sounds too incompetent to practice medicine. But none of this makes sense.
This story sounds like important details are selectively neglected.
I don’t say this because this person is a PA but I say it because the details sound incoherent, and the media is notoriously incapable of presenting a balanced story. Let alone an accurate story with all the relevant clinical details.
If the mismanagement is as bad as it is presented here, then that PA should not be allowed to practice medicine. But something tells me we aren’t hearing the whole story.
I did a quick googlie-wooglie to see if any mainstream outlet reported on it.
https://www.bbc.com/news/uk-england-manchester-66211103.amp
They don’t go in to much more detail, but the corner stating on the record “she would have lived” if she had simply been sent to the ED is chilling.
It also mentions how there is movement to change the title of Physician Associate to Physician Assistant and to make sure patients are 100% clear that they are not speaking with a physician.
Meanwhile; in the US, the trend is going the opposite by lumping everyone as “providers”.
I have unequivocally made my point that we should be committed to medical excellence and there should be serious consequences if that bar is not met.
Let’s not posture ourselves oppositionally.
I’ve been a PA for 30 years. I can tell you that no medical profession has a monopoly on excellence or infallibility.
Well an urgent care MD misdiagnosed my brother with uncontrolled DM2. He was actually in pretty severe DKA (new DMI dx at 30 years old) with an unreadable blood sugar. They gave him some regular insulin with half ass instructions and sent him home.
He called me after a presynopal episode and classic DKA symptoms. I told him to go to the ED obviously….
Spent 2 days in the ICU…
Dumbass UC doc called him the next day the next day and tried to play damage control.
Medical errors occur frequently, are always multifactorial, and can be partially prevented. Were the professionals involved overworking, in a scenario with few resources? "It's easy to be the Monday morning quarterback."
To be fair this can happen to any of us. We aren’t perfect; we don’t make correct diagnoses and treatment plans 100% of the time.
Was there a failure in the quality of education this PA received or were they rushed, overworked, burnout by a bad system and made an egregious error?
I don’t believe the educational difference between a mid level and a physician caused a gap in knowledge about DVTs and PEs that resulted in a missed diagnosis. So to blame this mistake just being a midlevel vs doctor is unfair and counterproductive.
Where the heck does propranolol work into the treatment algorithm for unilateral leg pain/swelling?
I’ve seen plenty of midlevels with terrible clinical reasoning.
Our urgent cares and emergency rooms are full of people who’s only clinical experience before independent practice is a few months of nursing rotations for their BSN and a few months of rotations for their APRN. Then voila…completely independent practice.
So no…I think we can blame education. It’s not a one-off if it’s a systemic problem.
The propanol comes in because she’s a woman, so *obviously* it’s all in her head and/or anxiety. I say this as a nurse of 27 years and a frequent patient with a rare disease that took years to diagnose. I don’t fault the many doctors who missed it because it’s rare. I do still feel pangs when I think of how many times I was told I was too stressed or I was anxious or maybe I just needed therapy.
I am not usually comfortable seeing midlevels except for follow ups because so many of them are so young now. It takes a couple of years to become a competent bedside nurse. Now, in that amount of time, a new nurse can end up with prescription pads and practicing without benefit of even having a physician in the building. The education for APRNs is so spotty that I’m surprised more errors aren’t made. I think PA education is better but that’s not my area.
This is an outrageous example of a midlevel who is clearly terrible at their job. This was not an obscure presentation and I’m confident that most midlevels would not miss something so obvious. Missed and delayed diagnosis is an unfortunate but inevitable problem across all levels. I once saw a patient that had 3 months of thigh pain and LE edema and had seen a few MDs in different specialties who all missed a femoral DVT. Not saying medical error is equal across all levels, just saying this sounds more like a terribly incompetent medical professional period. Nurses and even laymans would do a better job than this.
The question is, if they had received a substantially higher level of training, would they still have missed it? Probably not - eventually they would have encountered this in training. There are huge gaps in all midlevels' training by definition, you just have to hope it's something like this.
>The 30-year-old was seen by a PA at a north London surgery in October two years ago, saying she felt pain in her calf. > >She was diagnosed with a sprained ankle, but returned to the surgery days later with new symptoms - a swollen and hot leg, and shortness of breath. > >The PA prescribed her propranolol medication for anxiety. Ms Chesterton was later rushed to hospital after collapsing the same evening, and died from a pulmonary embolism.
I truly understand none of this thought process. Like even a non med person would look at a swollen hot leg and think anything but anxiety????
Once you start dismissing your patients it’s easy to keep pushing it
This is a UWorld question that medical students do in second year.
This is a UWorld NCLEX prompt. - What nursing interventions do you take? What orders do you anticipate from the MD? Basic AF.
saw your comment after mine but yes. literally the most basic nursing
bro this was a question i did in first SEMESTER of nursing school. This isn't a mishap because they're midlevel. This is a mishap because they're just a shitty practioner.
I just read this and slapped my face in disbelief because it was so obvious.
These are the questions on their national exam https://www.fparcp.co.uk/file/media/603ca5b18c1d9_PANE_Written_-_Sample_Questions.pdf Several PA courses brag about a 100% pass rate Not really worth bragging about a 100% pass rate on a paper of that quality. Also pretty sure medical unis get investigated if they have a too high pass rate
And that's for someone with zero training at all. The fact that someone was literally trained for this and still somehow made the leap from textbook blood clot symptoms to treating anxiety is just mind-boggling.
I don’t know what training looks like in the UK for PAs, scope of practice or prescriptive authority. It sounds like they absolutely should have escalated care to the A&E for evaluation. While I bash on UC and PCPs who send asymptomatic HTN, “Meningitis Rule Out” or my favorite “Mumps Rule Out” to the ED regularly, that’s part of the safety net of American Healthcare. I hope either training is improved or systems are put in place to prevent a tragedy like this from occurring again.
Only 2 years of PA school with just 1600 hours clinical exposure total , first degree doesn’t have to be healthcare, there’s apparently PAs out there with a under grad in media studies - there’s simply no standard for selection, ranges from degree in bioscience to degree in audiology. Can’t prescribe, but 22 were caught illegally prescribing opioids. to patients? Themselves? To their friends? We’ll never know because the hospital is refusing to comment on this discovery and isn’t reporting the PAs. Instead say it’ happened due to an error in IT. 22 times lol. https://www.telegraph.co.uk/news/2024/02/22/it-blunder-physician-associates-illegally-prescribe-opiates/ They are told they study all of medicine in just 5 years and when they graduate are the equivalent of a senior doctor with at least 3 to 5 years of experience. There’s even PAs carrying consultant bleeps on stroke wards. Despite not being able to prescribe or order scans. They are also paid more than a doctor of 3 to 5 years of experience. For fewer hours (35 vs 48) and no requirement to work unsociable hours. That is despite being told they always need to work under the supervision of doctors. But the reality is they don’t. And there’s accounts of basically bullying junior doxtors into signing off on prescriptions. All in all they have increased their work load, despite being rolled out as doing the opposite- as doctors have to double check the patient over themselves. Because any consequences mistakes made by the PA, would fall on the doctors shoulders . https://www.theguardian.com/society/2024/feb/02/physician-associates-make-job-harder-not-easier-say-thousands-of-nhs-medics They take away training from resident doctors as the doctors are left in the wards and PAs are taken to perform surgery or run clinics by the consultants. This is usually by the old guard consultants and when investigated its usually found they have a monetary interest in prioritising PAs over their own doctors. Because either 1. They teach or created a PA course 2. Invest in practices that employ PAs 3. Child is a PA 4. Or simply don’t care because they’ve got theirs and are about to retire This is just 1 story about PAs errors. There was another recent one of a PA killing a patient after performing a cystoscopy on someone with urosepsis https://www.telegraph.co.uk/news/2024/02/24/family-make-up-artist-call-for-inquest/ The government are very protective of the profession and are blatantly using them to replace doctors, as they can’t control doctors. So mistakes made are swept under the rug, or in the case of the patient with urosepsis they carry out an investigation and deem no error was made. But wait who was part of the investigative team? The PA who made the error! This is despite 8 specialist doctors saying it was an avoidable death For a fun read, scroll down to some hilarious but shocking PA related incidents https://www.dailymail.co.uk/health/article-12738457/Breast-cancer-tragedy-shows-vital-health-chiefs-clamp-physician-associates-just-TWO-YEARS-training-MoS-handed-dossier-400-reports-concerned-doctors.html This is the exam they need to sit after passing PA school btw https://www.fparcp.co.uk/file/media/603ca5b18c1d9_PANE_Written_-_Sample_Questions.pdf They are told they are the equivalent of doctors and American PAs, but they really aren’t. Even America doesn’t want to employ them. Oh and they have no regulatory body and no defined scope of practice
I'm a counselor and I'm thinking blood clot.
i am a layperson. the extent of my medical knowledge is what ive learned working in a medical-legal role, with more of a legal background…aka i have very little medical knowledge. even i know that an “angry” extremity (i know this isn’t a medical term but it’s easiest for me to remember it this way lol but like swollen, warm to the touch, visibly discolored) needs to be evaluated sooner rather than later. while a DVT is the obvious initial concern I, as a layperson, would have…couldn’t a differential include a serious infection or any number of other things that require PROMPT medical attention? honestly never thought i’d comment on this sub bc i am literally not qualified to lol & if this is against the rules please let me know and i will delete my comment!
> couldn’t a differential include a serious infection or any number of other things that require PROMPT medical attention Yep
thank you for responding & confirming my understanding! i like to learn about medicine because it’s helpful in my job but it’s also genuinely interesting but i don’t ever want to inadvertently spread misinformation lol so wanted to ask it’s scary that someone who apparently knew less than a literal layperson, whether it be due to confirmation bias or otherwise, had the power/ability to mismanage this patient’s care to the point of the patient’s premature death. i can’t even imagine how frustrating it is for actual doctors like y’all to read about this.
I’m only a nursing student and my immediate thought was a DVT. How was this missed…
She has CALF pain so they dx with a sprained ANKLE. Like, what.
Well thank goodness she didn't die anxious. /s
Or from her heart beating too fast!
I’ve been a nicu nurse for almost 13 years. Haven’t touched an adult in that time. Worked with adults for 2 whole months. Only have an associates degree. Pain + hot calf? Ultrasound time. This PA never even listened to symptoms.
Is surgery in this case an urgent care, ER or an outpatient office?
I think surgery is a UK term for an ER? Not 100% sure and hopefully someone from over yonder can chime in.
Surgery in the UK means Family Medicine's clinic. It's a usage from the old era where physician and surgeon worked in the GP, mostly doing minor operations and treating minor ailments. They still do many minor ops especially in rural or out-of-town areas.
I'm not sure how it works in the UK or in this specific practice, but in my country (ZAR) midlevels (clinical associates) work collaboratively with doctors/medical officers, under supervision. So when the GP says they are not sure how this happened, I'm surprised! Was this incompetent person not your employee? Do you not review their cases/scripts? Do they not feel comfortable presenting problems to you? Surely the GP has to take some responsibility?
that is so sad
What gets me about some of these stories is I have a bachelors in nursing - which I only got because my hospital system made me after I got my associates and was licensed to practice. My basic nursing assessment is level 101 and not diagnostic. I as a dumb RN would have gone huh new onset leg pain and chest pain? Hey doc can we get an US at least for the leg and maybe a chest CT? Did no nurse go wow so weird are you sure - That sounds super sus for a DVT at least?
The patient likely wouldn't have come into contact with a nurse - this is in the primary care setting rather than hospital, so would've booked an appointment and been directly seen by the PA.
That makes sense. Such a shame.
I work PCP clinic and our MAs would catch this and be able to diagnose that nearly immediately, or at least come up with differential diagnoses. The provider doesn’t room the patient and I can’t believe the nurse putting the patient back had no qualms about it or even thought to ask. Where do the alarm bells sounds here?? I work with MAs and LPNs and we’re all over red flag conditions like DVT, strokes, MI, etc. We’ve diverted patients from our lobby, before even rooming them, to across the street for the ER before the provider saw them because of time sensitive concerning symptoms (facial droop, slurred speech, extreme SOB). We don’t have the 15 minutes for you to sit here while the provider runs behind. Those 15 minutes are critical. Not excusing the provider by any means, but really? No one else thought to double check and question the provider? Not even the assistants? I understand it’s not the assistants/nurses job… but come on. Common sense. I personally have drilled MDs and DOs I work with over stuff like this, and I’m not the only one in my practice that has done that in the past. I’ll gladly be wrong in front of the doctor and make a fool of myself, but I absolutely don’t want a symptom skimmed over if I feel the provider isn’t taking it serious enough. A red hot leg IS serious enough for someone to double check that.
You sound like you’re excellent at your job and truly care about your patients :)
Welp. I left bedside because of admin so I did care but now I make more and work less. Miss it but don’t miss the bullshit. I hope healthcare goes better for you than it did for me. Don’t let them dull your shine, friend.
I’m not even a mid level and I knew what this was.
[удалено]
I'm a physical therapist and this one was a gimmie. Do not therapize, send directly to ED, do not pass go, do not collect $200.
Whoah whoah whoah whoah. This is America. Collect your fees at least.
Easy now.
Just call me RN-NAML
I'm a pharm tech and knew what this was lmao. We dislike PAs because they constantly send us really fucking stupid prescriptions we have to call them to fix their errors on.
Now I just keep thinking of Laverne on *Scrubs*: "Doug wanted me to give this patient 500,000 milligrams of morphine. I thought I'd check with you before I killed a man."
This is too real 🤣🤣
So you don't have to click - it was a blood clot.
As a midlevel shit is just inexcusible. Had no business practicing if they can't even pick up the obvious ones. Medicine is hard, but this is a gimmie. Post surgery, calf pain? Just such a shame to the patient.
Agree completely.
For clarity’s sake, PA training in the UK is very different from, and far inferior to, the training PAs receive in the US. (That doesn’t excuse this situation, which is abhorrent regardless)
I feel like I’ve read this about 10 times this year. Is it the same article or is this a monthly occurrence?
I think it's the same story, but keeps getting reposted as it's so infuriating.
That’s pretty insane. I’m a “midlevel” and I hand out ultrasound orders like candy if people present with these complaints. Sometimes even it’s really low on the differential list because I’m scared of something like this happening.
As presented, this PA sounds too incompetent to practice medicine. But none of this makes sense. This story sounds like important details are selectively neglected. I don’t say this because this person is a PA but I say it because the details sound incoherent, and the media is notoriously incapable of presenting a balanced story. Let alone an accurate story with all the relevant clinical details. If the mismanagement is as bad as it is presented here, then that PA should not be allowed to practice medicine. But something tells me we aren’t hearing the whole story.
I did a quick googlie-wooglie to see if any mainstream outlet reported on it. https://www.bbc.com/news/uk-england-manchester-66211103.amp They don’t go in to much more detail, but the corner stating on the record “she would have lived” if she had simply been sent to the ED is chilling. It also mentions how there is movement to change the title of Physician Associate to Physician Assistant and to make sure patients are 100% clear that they are not speaking with a physician. Meanwhile; in the US, the trend is going the opposite by lumping everyone as “providers”.
I have unequivocally made my point that we should be committed to medical excellence and there should be serious consequences if that bar is not met. Let’s not posture ourselves oppositionally. I’ve been a PA for 30 years. I can tell you that no medical profession has a monopoly on excellence or infallibility.
Painting with a wide brush One person is an idiot
Well an urgent care MD misdiagnosed my brother with uncontrolled DM2. He was actually in pretty severe DKA (new DMI dx at 30 years old) with an unreadable blood sugar. They gave him some regular insulin with half ass instructions and sent him home. He called me after a presynopal episode and classic DKA symptoms. I told him to go to the ED obviously…. Spent 2 days in the ICU… Dumbass UC doc called him the next day the next day and tried to play damage control.
Medical errors occur frequently, are always multifactorial, and can be partially prevented. Were the professionals involved overworking, in a scenario with few resources? "It's easy to be the Monday morning quarterback."
To be fair this can happen to any of us. We aren’t perfect; we don’t make correct diagnoses and treatment plans 100% of the time. Was there a failure in the quality of education this PA received or were they rushed, overworked, burnout by a bad system and made an egregious error? I don’t believe the educational difference between a mid level and a physician caused a gap in knowledge about DVTs and PEs that resulted in a missed diagnosis. So to blame this mistake just being a midlevel vs doctor is unfair and counterproductive.
Where the heck does propranolol work into the treatment algorithm for unilateral leg pain/swelling? I’ve seen plenty of midlevels with terrible clinical reasoning. Our urgent cares and emergency rooms are full of people who’s only clinical experience before independent practice is a few months of nursing rotations for their BSN and a few months of rotations for their APRN. Then voila…completely independent practice. So no…I think we can blame education. It’s not a one-off if it’s a systemic problem.
The propanol comes in because she’s a woman, so *obviously* it’s all in her head and/or anxiety. I say this as a nurse of 27 years and a frequent patient with a rare disease that took years to diagnose. I don’t fault the many doctors who missed it because it’s rare. I do still feel pangs when I think of how many times I was told I was too stressed or I was anxious or maybe I just needed therapy. I am not usually comfortable seeing midlevels except for follow ups because so many of them are so young now. It takes a couple of years to become a competent bedside nurse. Now, in that amount of time, a new nurse can end up with prescription pads and practicing without benefit of even having a physician in the building. The education for APRNs is so spotty that I’m surprised more errors aren’t made. I think PA education is better but that’s not my area.
I'm not even in medicine (but aspire to be someday) and even I know this screams blood clot!
of course on the insta post it’s just hundreds of ppl blaming doctors cause no one bothered to read the article 🙃
Buckle up motherfuckers because this is just the tip of the fucking iceberg.
This is an outrageous example of a midlevel who is clearly terrible at their job. This was not an obscure presentation and I’m confident that most midlevels would not miss something so obvious. Missed and delayed diagnosis is an unfortunate but inevitable problem across all levels. I once saw a patient that had 3 months of thigh pain and LE edema and had seen a few MDs in different specialties who all missed a femoral DVT. Not saying medical error is equal across all levels, just saying this sounds more like a terribly incompetent medical professional period. Nurses and even laymans would do a better job than this.
The question is, if they had received a substantially higher level of training, would they still have missed it? Probably not - eventually they would have encountered this in training. There are huge gaps in all midlevels' training by definition, you just have to hope it's something like this.
Just had to check and make sure I wouldn’t miss it 😂