Missed diagnosis

A GPST saw a six-month old infant who presented with a temperature of 38.2°C with a recent history of diarrhoea and vomiting. She found no rash and noted that the child was alert and his chest was clear and there was no evidence of respiratory distress although his throat was mildly inflamed.

Diagnosing a viral illness, the GPST advised the baby’s mother about some of the major ‘red flag’ symptoms and how to seek further help if her son’s condition deteriorated. She considered seeking the opinion of her supervisor but the practice was short-staffed that day and she didn’t want to waste his time.

The following day the child was admitted to A&E with fits and was subsequently diagnosed with pneumococcal meningitis. Fortunately, he made a full recovery but his parents accused the GPST of failing to make a proper assessment and failing their son by not arranging for him to be admitted to hospital.

The practice investigation found that the GPST had made a meticulous record of her examination, including her negative findings and the advice given. However, she carefully reflected on what had happened and explained to her supervisor her regret at not seeking input from a more experienced colleague and admitted she was not familiar enough with the relevant NICE guidelines on assessing fever in the under-5s.

The practice response to the complaint included the GPST’s honest and insightful comments, along with her apology for what had happened, and it also emphasised what had been learnt. The parents accepted the apology and explanation; they were particularly reassured that the GPST had clearly understood the lessons from the incident.

MDU advice

• You have an ethical duty to recognise and work within the limits of your competence. Seek advice if you encounter something in which you have little experience or if you are unsure of how to proceed.
• Meningitis is notoriously difficult to diagnose in its early stages because the signs are similar to many other common illnesses. With any diagnosis, it helps to have a detailed record of the examination, positive and negative findings and advice. This will assist colleagues who may subsequently see the patient and will be important if the standard of your care is called into question.

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