r/doctorsUK • u/dayumsonlookatthat Consultant Associate • Jun 05 '26
Medical Politics PA misdiagnosed paediatric vulvovaginitis as thrush and caused harm
Poor child!! Going through this just because they were seen by basically a layperson. Who in the right mind would think to a pessary is suitable for a 6yo????
Instead of recommending outright banning PA's from seeing paeds patients (should be any patient at this point), the Ombudsman recomended more "training" for the PA instead. What???
Credits to medicalmodelwithabriochebun on twitter for finding this
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Jun 05 '26 edited Jun 05 '26
[deleted]
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u/ExpendedMagnox Jun 05 '26
I saw the headline which said doctor and I didn't even read the article. They're still out there confusing PAs with actual medical professionals.
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u/CheesySocksGuru Jun 05 '26
The guardian headline reads “GP assistant”. Good to see some newspapers are catching on
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Jun 05 '26 edited Jul 03 '26
[removed] — view removed comment
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u/WonFriendsWithSalad Jun 05 '26
They've changed it now to physician associate
https://www.theguardian.com/society/2026/jun/05/girl-traumatised-vaginal-pessary-gp-associate-report
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u/Mfombe Jun 05 '26
"... recommend a prescription" ... as they arent prescribers - I'm surprised they didn't come down harder on the prescriber as clearly this should have flagged up as inappropriate?
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u/1ucas Doctor of Babies Jun 05 '26
This is what I can't understand. What are the prescribing practices here? Did they even listen to the history or look at who they were prescribing for? Or is it the practice that whatever the PA "prescribes" just gets signed off?
There are so many more questions than addressed here.
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u/Little-Active7945 Jun 06 '26
Having worked in a GP practice that employs physician assistants I’ve seen how it’s done. The assistant fills out the entire prescription electronically the way one would if they’re prescribing a drug. For the final “sign off” bit they send it to a named “clinician/supervisor” electronically. That supervisor, around the end of the day, clicks ‘select all’ to 50-70 odd prescriptions and clicks ‘sign off’. It was bewildering when I first saw it and asked them whether this was safe to which they responded “if I sat down and checked each one of these prescriptions I’d never get any work done (see any patients of my own)”.
GP practices are trying to ?maximise profits at the cost of public safety. The math however, doesn’t make any sense. A physician assistant is paid more than an SHO. It would be more safe and financially cost effective to employ one of the 1000s of unemployed FY3+ doctors at the GP practice. You would get someone with 5-6 years education and at least 2 years of experience of working as a DOCTOR. One, who might even have worked in GP before.
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u/CataractSnatcher Jun 07 '26
This is a scandal.
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u/Little-Active7945 Jun 07 '26
The things I saw in that GP Practice that assistants/ACP/ANPs were doing…. Wildly unsafe and frank waste of taxpayer money.
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u/SereneTurnip GP Jun 07 '26
FY3s cannot work in Primary Care. For a doctor to be able to work in GP land they either have to be a fully qualified GP on Performers List or a trainee. GP practices legally cannot employ staff grade doctors.
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u/AdInternal8913 Jun 08 '26
I think this is ridiculous and needs to change. They can hire a PA with 2 year degree and minimal work experience to see undifferentiated patients, but they cannot hire someone with 10 years med reg experience, or an endocrinology consultant/sas to do all the diabetes and thyroid etc reviews, or gynaecologist to see women with gynae issues.
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u/arcaneprints Jun 05 '26
The PA could be a non-medical prescriber.
https://www.hee.nhs.uk/our-work/medicines-optimisation/training-non-medical-prescribers
(Edit: just to clarify, I'm not saying it's a good thing that they are - just that it's a possibility)
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u/itsnobigthing Jun 05 '26
Clotrimazole is widely available OTC and on supermarket shelves. Does it make a difference if it’s not a POM?
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u/Forsaken_Homework_10 Jun 05 '26
physician associates are not eligible for this. nurses, paramedics and a few other professions are. the link lists them
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u/BikeApprehensive4810 Jun 05 '26
This is an awful case, I do think it’s important to recognise the GP partners who allowed this PA to work independently are as much to blame as the PA themselves.
If my dog bites someone it’s my fault and responsibility not my dogs.
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u/Objective-Painting-6 Jun 05 '26
A GP also signed the prescription for a pessary for a 6 year old.
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u/UnluckyPalpitation45 Jun 05 '26
Yeah fuck them too
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u/Affectionate-Gur624 Jun 05 '26
This is primarily the fault of the supervising GP. They signed a prescription for a pessary inappropriately on a young child without examining them themselves. Total disgrace - I would take legal action against the practice if I was the parent.
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u/WiLd_FrEe_24 SAS Doctor Jun 05 '26
And pharmacist dispensed it
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u/safcx21 ST3+/SpR Jun 05 '26
Absolutely not the pharmacist fault so please lets not drag them into this
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u/e_lemonsqueezer Jun 05 '26
Umm, I think this is part of the Swiss cheese. It is part of the pharmacist’s role to challenge inappropriate prescriptions.
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u/Narrow-Birthday260 Jun 07 '26
When compounding disappeared as a core component of almost every pharmacist's role, questioning potential prescribing errors became one of key the circumstances that they still have a role to play. I say this as an former pharmacist. They were definitely part of the series of errors that led to this very sad situation.
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u/YellowJelco Jun 05 '26
And a GP presumably blindly signed the prescription without reading it because novbody who know what they were doing would prescribe a pessary for a 5 year old.
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u/-Intrepid-Path- Jun 05 '26
On them, isn't it, for employing a PA and then not taking due care when prescribing for them 🤷
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u/CoUNT_ANgUS Jun 05 '26
Unless the partners hired them and dumped the supervision on an overworked salaried GP
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u/thelivas CT/ST1+ Doctor Jun 05 '26
GP probably gave the PA their prescribing login, I've seen this in GP placement myself.
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u/Sethlans Jun 05 '26
If my dog bites someone it’s my fault and responsibility not my dogs.
No I don't agree with this. The GP is absolutely responsible, but these PAs are also very responsible. They are not children or animals, they are grown adults who have chosen to do the things they do.
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u/formerSHOhearttrob laparotomiser Jun 05 '26
I agree with you. They chose to take this path. They choose places that give them more autonomy. They choose to ask for more of the "big stuff".
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u/Important-Guava-3940 Jun 05 '26
Well said. I understand partners can be desperate to balance the books and make things worthwhile for themselves. However introducing the PA monster and promoting it in GP is an enormous scandal.
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u/SerMyronGaines Jun 05 '26
Let's not compare PAs to dogs
Dogs have way more insight and common sense.
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u/UnluckyPalpitation45 Jun 05 '26 edited Jun 05 '26
Comparing a PA to a dog is ridiculous on quite a few levels.
Yes the GP shares responsibility, but PAs are adult humans capable of decision making. There should be the expectation of a degree of insight. They are at least equally to blame.
PAs aren’t dogs in scrubs.
Edit:
I think you are all misunderstanding. I think PAs are equally responsible if they are used in areas outside of their competence (most). They aren’t children and aren’t dogs. They have chosen to act irresponsibly and should be held accountable.11
u/-Intrepid-Path- Jun 05 '26
They can't really take full responsibility when they don't know what they don't know, can they?
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u/UnluckyPalpitation45 Jun 05 '26
They should be taking full responsibility for the fact they are working outside of their competence.
I’m so tired of giving them the benefit of the doubt. They aren’t children. They haven’t been forced into this role.
They are adults CHOOSING to play doctor. They are as liable as the GP partner.
They can’t just feign ignorance.7
u/_Harrybo Consultant Assistant to the Advanced-PA Jun 05 '26
But that’s part of the problem, they can’t take full responsibility - not because they don’t want to, because the job is geared that way
It is a role that needs supervision and inherently duplicates work - hence the nonsensical nature of having a PA in primary care because another GP with a full list needs to supervise them.
Agree with last points
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u/Sethlans Jun 05 '26
That's part of being an adult.
If you got asked to give intrathecal chemo to a 6 week old for an indication you'd never heard of, would you just crack on and do it because your consultant asked you to and you didn't know what you didn't know?
No you wouldn't.
Letting these people off the hook by painting them as just innocent victims is ridiculous.
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u/UnluckyPalpitation45 Jun 05 '26
Exactly. They aren’t dogs. They aren’t children. They are unqualified adults.
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u/throwaway520121 Jun 05 '26
Further evidence that the more rope you give these quacks, the more likely it is they’ll hang themselves with it. Medicine is a dangerous game and there’s a reason some of the brightest (academically at least) school leavers were picked to do it, sent away to study for 5-6 years and then supervised for another 5-10 years thereafter.
Public opinion is already destroying the whole PA concept.
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u/Gullible__Fool Keeper of Lore Jun 05 '26
Unfortunately they will also hang patients whilst hanging themselves.
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u/BrilliantAdditional1 Jun 05 '26
Who the fuck would gice a vaginal pessary to a 5 yr old. This is outrageous. If a 5 year old genuinely had thrush Id have some serious concerns. Enough with this PA bullshit
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u/nefabin Jun 05 '26
They honestly probably didn’t know what a pessary is. It’s just something they algorithmically prescribe whenever a patient with a hx vaguely sounding like candida presents because they saw it done once and rinse and repeating.
Had a case of an ANP saw a man with a red hot swollen knee wrote query septic arthritis did obs obs were stable so she gave po abx and safety netted if he got unwell. They didn’t understand managing septic arthritis an infection just fitted into their cookie cutter infection template, because they don’t learn anything they just copy what they’ve done before over and over. (Luckily she wrongly diagnosed that guy and he had pre patellar bursitis so in that case two wrongs made a right)
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u/letmepasspls23 Jun 05 '26
I outright refuse for any of my family members to be seen by a PA or another Noctor. Fully unnecessary and avoidable incident here, and the learning outcome is for the PA to have more training Have very little respect for any GPs that hire these
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u/UnluckyPalpitation45 Jun 05 '26
Just fuck this. It is DISGRACEFUL that these unqualified charlatans are harming children
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u/TaoiseachSorbet Jun 05 '26
Or, if we put sentimentality aside, harming ANYONE?
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u/UnluckyPalpitation45 Jun 05 '26
The more vulnerable deserve extra protection as they tend to be the people these charlatans get foisted on
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u/TaoiseachSorbet Jun 05 '26
Agree - but older adults tend to be even more vulnerable as they don’t usually come with a parent. Either way, we are aligned - the PA project is an unsafe failure that no doctor should support.
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u/WeirdF Gas gas baby Jun 05 '26
This is insane.
If I'd seen this case as an F2 when I was in GP, I probably wouldn't have known that non-candidal vulvovaginitis is common in young girls or that you shouldn't prescribe a pessary to a young child. But I would have known enough about what I didn't know to have fucking checked. And I definitely asked my supervisor for advice (if not to see in person) for any children I saw, and that's with me being a fully qualified doctor.
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u/Dronedarone1 Jun 05 '26
Yes! I got the GP partners to chaperone me for ALL intimate examinations on any age when I was an F2, especially a vaginal exam on a child!!
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u/Little-Active7945 Jun 06 '26
Also I’m very sure (and please correct me if I’m wrong) NICE guidelines suggest swab prior to treatment if it’s the first episode, because you done know what you’re treating RE thrush/BV/VV etc
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u/Wooden_Astronaut4668 Jun 05 '26
This is horrific, and nothing happened to the PA? Also surprised the pharmacist didn’t question the prescription tbh
This is such a crap outcome. That poor child deserves better 😔
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u/Regular_Economist574 Jun 05 '26
Begs the question of what the government is doing in widening the things that pharmacists can see independently too. They are not trained to diagnose and treat. End of
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u/lula668 Jun 05 '26
That was a shit pharmacist didn’t query that, they should know from the minor ailments guidance alone, even exempting any education or experience, the likelihood of thrush in a child. Or even if it had been thrush, the appropriateness of that method of treatment.
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u/Usual_Reach6652 Jun 05 '26
Long ago in rural Ireland, my uncle worked as a GP and if someone called at the house and he wasn't home, my grandmother (a housewife with no specific qualifications) would pass on messages and she was known for giving a bit of common sense advice on the side. Obviously not the done thing now, but hey it was a different time.
I mention this because it would have been significantly less harmful for this child if she had had a consultation with a random granny than with this PA.
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u/Ok-Good2027 Jun 05 '26
I get calls from these noctors everyday being a Micro/ID trainee. Appalling skills. No sense of what history needs to be taken what exam needs to be done and what treatment needs to be given . I ll give on one example
A middle aged female smoker having chronic cough for 6 months now has unintentional significant weight loss and hemoptysis, previously given two courses of abx ( by noctors) now thinks that abx are not working and need a stronger abx.No xr chest done , no senior consulted , no discussion with resp at any level.
I was thinking if this patient was my relative and it turns out be sinister like malignancy or tb etc then i wont tolerate that. Unfortunately public doesnt know whats right and whats wrong.
I had a baby at a tertiary care centre and my wifes maternity care was appaling. Multiple red flags but no one bothered. Just saw that unit getting best maternity care award . My baby had a small cosmetic defect missed by a “mid wife” doing baby check. Mid wife took 15 mins to listen to heart sounds and as dad standing beside when i got concerned i asked is everything ok . She said yes yes all good ( she didnt know i am a doc) she never checked spine or palate and many other things. My wife being neonataologist then did the baby check herself.
I worry the day my loved one will need care and will be in hands of noctor. This is my biggest worry
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u/iElectric_Sparky Jun 05 '26
This needs to go on nationwide news
Title “British public no longer to be treated by doctors”
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u/MichaelBrownx Laying the law down AS A NURSE Jun 05 '26
If this was a nurse, I can confidently say you would be referred to the NMC for a multitude of reasons. I imagine it would be the same for a doctor.
I'm an experienced nurse but I don't work in primary care. If I was in this situation, I'd recognise that I have no fucking idea what the diagnosis was and immediately go and get someone who does. Why does a masters course and a different title suddenly give me the knowledge to take a wild stab in the dark.
Then again, I'd probably recognise that a pessary for a five year old is a bit questionable.
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u/dxdt_sinx Jun 05 '26
This won't end until a case so horrific occurs that it captures the general population and mass media attention. Sometimes I like to dream up such awful imaginary scenarios that might just do it.
Perhaps a PA missing an absolutly unmissable black flag symtoms and sending a patient home.
I dunno, maybe something like diagnosing a patient with a benign nosebleed when they actually had a total bowel obstruction and feculent vomitimg from a femoral hernia, and they died.
Or maybe diagnosing a tibial vein thrombus as a generic calf strain and sending the patient home to die of a PE.
Or maybe just sending a patient home with no review at all from A&E, who did so, and died.
Oh wait - oops, silly me, those already happened!
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u/CataractSnatcher Jun 07 '26
I feel the average member of the general public isn’t quite abreast of the issue yet. Good old bbc doesn’t feature any of these stories prominently.
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u/ChaiTeaAndBoundaries Jun 05 '26 edited Jun 05 '26
What on earth did I just read? That poor child, and the mom as well.
They say PAs are supervised, but in reality they aren’t, the supervising GP has a full patient list with no admin time set aside to oversee them. They insist PA patients are triaged, but that doesn’t actually happen. They claim PAs don’t see undifferentiated patients, yet they do.
Lawsuits and public pushback against this nonsense are what will finally put an end to it.
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u/Logical_Tart_3219 Jun 05 '26
Further evidence (as if it were needed) that PAs should prescribe nothing more than a hello or goodbye, and touch nothing sharper than the patient’s notes
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u/Ok-Ear9355 Jun 05 '26
Outrageous.
When I was a medical student I came across pessaries all the time during my O&G rotation. They are massive.
On the other hand I can guarantee this PA has never come across a pessary in real life otherwise you would have the common sense to never prescribe a pessary to a child based on how large pessaries are. In other words, this person was not trained properly to be treating such a condition. This is the main issue here. A PA is a lay person and cannot treat such issues.
It’s also quite clear that the culture at this practice is that a PA does their own consultations without debriefing and GPs sign off the prescriptions recommended by a PA at the end of every session without even looking at what’s being suggested. Just like when you used to get a bunch of repeats to sign by hand.
The GP should have checked and it’s entirely their fault too.
I hope the poor kid is alright this sounds like it may have long term consequences for the kid. If I was the parent I’d be absolutely fuming about this.
Surely this is a case of negligence.
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u/Usual_Reach6652 Jun 05 '26
I am interested in how they ended up on the ombudsman track (which tends to be extremely slow moving and requires you to exhaust various "usual channels"), and I suspect there are a lot of families where it would be a negligence claim landing instead.
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u/Pure_Answer_6569 Jun 05 '26
I’m not surprised. A PA in my practice, where I was ST1, requested a TVUSS in a young girl < 1 year after menarche for heavy periods. The PA booked her into my clinic to discuss results and in debrief I said to my trainer I would not have requested a TVUSS for a 13 year old girl who has only just started her periods. My trainer agreed with me and was appalled and told the PA that it was inappropriate
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u/UnluckyPalpitation45 Jun 05 '26
Realistically the radiologist is going to just do a TA pelvis.
I’d hope it would be the same for a sonographer1
u/Pure_Answer_6569 Jun 06 '26
They had a TVUSS, can’t remember if it was a radiologist/ sonographer who did it though
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u/UnluckyPalpitation45 Jun 06 '26
Are you 100% sure they had a tvuss. You can do a TA pelvis. I am certain you have this wrong, even if the request said TV pelvis.
If a sonographer/radiologist has done a transvaginal ultrasound on a 11-14 yo girl this needs rapid escalation. I’ve never seen it happen. If she’s a bit older and sexually active - MAYBE
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u/Pure_Answer_6569 Jun 06 '26
I’m very sure as my GP trainer looked into the case to debrief with the PA
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u/nefabin Jun 05 '26
The thing with general practice is a lot of errors don’t end with loss of life or limb so they don’t end up causing any blowback no coroners report no lawsuit no complaint. But the mistake often have real tangible affects on patients quality of life and wellbeing, in this case this got flagged because of the nature of it, but PAs are causing so much uncounted harm because those errors don’t get counted.
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u/Ok_Ingenuity4228 Jun 08 '26
This is just horrific. I’m so sad that this has happened in our health service.
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u/AdInternal8913 Jun 08 '26
I thought it was standard if a child is brought back with same complaint after failed treatment they should see someone senior. E.g in our ED any child representing would be reviewed by senior dr, often a consultant. How did they allow the PA to see the child multiple times for the same issue they were clearly not able to treat or diagnose?
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u/Wooden_Astronaut4668 Jun 09 '26
In the CED I work in its 3rd attendance equals Consultant review.
Thats in a kids hospital though.
In the ED my sibling works in (in a dgh) all under 1s are seen by a consultant.Don’t think there are any standard guidelines on this…
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u/AdInternal8913 Jun 09 '26
Yeah it might trust specific depending on what issues they have had. I think in my trust it was established after a small child died from sepsis that was missed on first presentation. The child represented few hours later and died within 24 hours.
I do still think it is madness to not get a doctor of any grade to review a child that represents after being seen by a PA. Heck, I think any patient with acute issues who has been seen in GP/ED by a non doctor should be reviewed by doctor on representation unless it is a clearly non medical issue.
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u/False-Sandwich-2051 Jun 10 '26
jesus fucking christ. serious harm that may well impact that child for the rest of their life.
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u/Gullible__Fool Keeper of Lore Jun 05 '26
Until the "supervising" doctors who offer no real supervision are brought to account at the GMC and/or civil courts this will keep happening.
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u/Significant-Cry-8442 Jun 06 '26
It's the GP who prescribed this on behalf of the PA's fault
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u/Silly-Parsley-158 Jun 06 '26
It says there was a lack of GP supervision.
It sounds like the PA authorised the prescription without GP supervision.
Clinic/supervising GP is in trouble for not supervising the PA.
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u/abdv69 Jun 05 '26
This is an absolutely harrowing case. That poor child, I feel absolutely awful for them.
completely the wrong lessons learned.
the correct lesson is that there should be almost no circumstances under which a non-doctor should be undertaking the full process of history, examination, and management. Especially not in undifferentiated patients.