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Presentation of infant with illness later diagnosed as meningococcal septicaemia (03HDC06973)

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(03HDC06973, 25 June 2004)

General practitioner ~ Meningococcal disease ~ Standard of care ~ Professional standards ~ Information about condition ~ Rights 4(1), 4(2), 4(4), 6(1)(a), 6(1)(b)

A woman took her son, aged two and a half, to a medical centre one morning after he had vomited three times within half an hour of waking, did not like the light or being held, and was drowsy. A registered nurse who examined him was concerned about his high temperature and other symptoms, and spoke to the GP, who examined the boy immediately. His mother asked whether he might have meningitis; since the GP had found no neck stiffness, rash, or enlargement of the lymph nodes he replied in the negative. His other findings, recorded in his notes, led him to conclude that the child had a viral illness, with a probable respiratory tract infection and gastroenteritis. He prescribed paracetamol to control the boy's temperature, and advised the mother to observe him carefully, give him small amounts of fluid regularly to keep him hydrated, and to watch for a rash and seek urgent medical attention if she found one or if the boy did not improve (the mother, however, did not recall being given this advice).

A Pamol suppository was given by the nurse on verbal instruction from the GP, and she also watched the child for a short while so that the mother could visit the pharmacy across the road. The nurse observed that while he was clearly unwell and feverish-looking, his condition did not appear unduly serious at that time. The mother and child returned home, where he continued to vomit, even in his sleep. That afternoon she noticed a rash on him and, since he was still vomiting, feverish, drowsy, sensitive to light, and not wanting to be picked up, she took him to hospital. He was diagnosed with meningococcal septicaemia and suffered renal failure, amputation of his right foot, and the loss of a thumb and two fingers on his right hand, plus extensive permanent scarring because of septicaemia.

The woman complained that the GP did not diagnose her son's illness correctly, was too casual in his examination, and did not exercise caution in sending him for further tests in hospital; also, that he did not advise her of symptoms indicating meningococcal disease.

It was held that the GP exercised reasonable care and skill in examining the child and forming his diagnosis; he specifically checked for signs of meningitis, and further tests were unlikely to have been helpful. Many of the symptoms of meningococcal disease are also common symptoms of other severe viral illnesses and, at the time of the consultation, there was no indication that further medical intervention was necessary. The GP appropriately advised the woman to seek urgent medical attention if a skin rash appeared or the child did not improve. Accordingly, he did not breach the Code.

However, it was of concern that the GP did not make himself available to speak with the child's family following the incident, despite the matter being referred to advocacy. Many complaints are the result of a lack of communication and understanding between the parties, and taking the initiative to address the issues promptly can save a lot of time and unnecessary ill feeling.

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