A rare fever - Medical case study

BACKGROUND: GP, Dr Y, is called out to the home of a 61-year-old man, Mr J, who presents with a three-day history of fever and fatigue. He tells the doctor he has recently returned from a holiday in India. Dr Y examines Mr J, measuring his temperature by hand, and diagnoses him with influenza, prescribing a course of antibiotics.

Mr J takes the medication but his condition deteriorates over the next two days and he begins to have difficulty breathing. His family call an ambulance and he is taken to hospital where he is diagnosed with falciparum malaria. He is immediately given the appropriate drug treatment but his condition does not improve and Mr J dies a week later.

Mr J’s family lodge a claim of clinical negligence against Dr Y, arguing that he would still be alive had he been referred to hospital for treatment during the home visit.

ANALYSIS/OUTCOME: Dr Y informs MDDUS of the claim and writes a detailed summary of the circumstances of Mr J’s case. He explains that he had carried out a full examination of Mr J but had not considered malaria as a potential diagnosis, despite being told the patient had recently been on holiday. He adds that he has written a letter of apology to the family, reassuring them that he has since undergone further training in malaria diagnosis.

MDDUS, acting on behalf of Dr Y, commission expert reports from a GP and a consultant in infectious diseases. The reports are critical of Dr Y’s failure to consider malaria and did not support his diagnosis of influenza. An adviser discusses the reports with Dr Y and they agree that it would be in his best interests to settle the case.

KEY POINTS

• Tropical diseases should always be considered in all cases of fever in patients who have been abroad, whether to malaria regions or not.
• Where fever is the main/only symptom, consider using a thermometer to achieve a more accurate temperature reading.
• Prompt diagnosis and referral is a matter of urgency in malaria.