Dr G is a locum GP working for an out-of-hours service. She takes a call in the early hours of the morning from a mother with a sick child. Mrs P’s two-year-old daughter Sara has woken up vomiting and with a high temperature. Mrs P is worried because Sara is much less responsive than usual.
Dr G asks if Sara has any rashes or neck stiffness and when Mrs P says no the GP suggests that Sara is likely to be suffering from a tummy bug. She advises Mrs P to put her in a tepid bath to bring down her temperature and give her Calpol.
Dr G also discusses the possibility of meningitis with Mrs P and the significant symptoms to look for. She advises Mrs P to phone back if Sara’s condition worsens or if she has any worries and that she should consider visiting her own GP in the morning if the symptoms have not improved. A record is made of the call and the advice given.
Next morning Sara is still sick and listless with a high temperature and Mrs P phones her local surgery for an emergency appointment. One is arranged for 11:00 am that morning. Not long after the phone call a neighbour drops by and looks in on Sara who is now pale and limp with a fixed gaze. She also notices a large purple mark on Sara’s leg. The neighbour advises Mrs P to call an ambulance immediately.
Sara is transported to hospital and diagnosed with bacterial meningitis. She is admitted to ICU and kept in an induced coma for five days while being treated with antibiotics. She makes a full recovery though Mrs P is advised to take her for regular sight and hearing tests.
A few weeks later a letter of complaint from Mrs P is received by the out-of-hours service and copied to her local surgery.
Analysis and outcome
In the letter Mrs P states that she felt given Sara’s poor condition a doctor should have made a home visit either in the early hours or later that morning. Had a doctor examined Sara her condition would have been diagnosed and treated sooner.
Dr G contacts MDDUS and forwards a copy of the letter, rightly concerned that the matter could escalate into a claim of negligence. She is convinced her actions in the case were reasonable and appropriate. MDDUS advises Dr G in her written reply to Mrs P.
In her letter Dr G first expresses her regret at the suffering Sara endured. She then explains that meningitis is a relatively rare and insidious illness and difficult to diagnosis, especially in the early stages when there may be no rash or other more distinctive features present. Vomiting, high temperature and listlessness are common symptoms and in most cases due to viral gastroenteritis.
Dr G further writes that had she any doubt at the time of the call that Sara’s symptoms were indicative of meningitis she would have paid a home visit immediately – and that she was sorry if Mrs P perceived her manner as dismissive.
A subsequent meeting with Mrs P is arranged at which the issues are further discussed and the matter goes no further.
- Have a higher index of suspicion in phone consultations over a febrile child and arrange to see the child if in any doubt – especially if you are a locum dealing with an unfamiliar patient or family.
- Come up with a management plan which can be understood by the patient and ensure a ‘safety net’ is in place, i.e. the patient or carer should be clear what to do if a condition does not improve or deteriorates.
- Take comprehensive notes of what is discussed/advised.