General practitioner ~ House-call
service ~ Diarrhoea and vomiting ~ Rash ~ Diagnosis ~ Meningococcal
meningitis ~ Record-keeping ~ Disposal of syringes ~ Standard of
care ~ Professional and ethical standards ~ Rights 4(1), 4(2)
A woman complained that a general practitioner (GP) failed to
diagnose meningococcal meningitis and meningococcaemia. She
contacted her own doctor's surgery after 24 hours of diarrhoea,
vomiting and dizziness. The receptionist arranged for a doctor from
a house-call service to visit the woman.
The GP examined her and, on the basis of his examination,
excluded a diagnosis of meningitis and concluded she was suffering
from viral gastroenteritis. He gave her two codeine tablets and an
injection of an anti-nausea drug, and left the syringe for the
household to dispose of.
About half an hour after he had left the woman's house, a
relative telephoned to say that the woman's head had begun to throb
badly. Once he had ascertained that she was not showing signs of
shock, he advised they wait until the immediate effect of the drug
had passed. He did not hear anything further and so assumed all was
The following day the woman had developed a generalised rash and
a stiff neck. She was photophobic and vomiting and thought she had
contracted meningitis. She had developed a rash on her legs, but
her temperature was within normal limits, and her pulse, throat,
ears, chest and abdomen were all normal. The GP was called and came
to the house at 1pm. He felt that her condition had improved and
his fears with regard to meningitis were allayed. He attributed the
rash to a reaction to the codeine.
It was not until a third house call, made by a different doctor,
that the woman was referred to a hospital, where she was diagnosed
with meningococcal meningitis and meningococcaemia.
It was held that the GP's assessment and diagnosis at the first
visit were appropriate. It was not acceptable, however, to leave
the used needle and syringe at the house. His clinical records did
not meet professional standards and breached Right 4(2).
It was also held that the GP breached Right 4(1), as it was a
serious error of judgement not to consider other diagnoses and, by
advising the woman that the rash was a reaction to the codeine, he
falsely reassured her about the cause of the rash.