Meningitis is a rare but serious disease. On average there are only around three cases per 100,000 people every year in the UK, and with the introduction of immunisation programmes it's unlikely that you’ll encounter it more than once or twice in your entire career, if at all.
Meningitis can be fatal, and survivors can suffer severe complications including brain and limb damage. The disease is notoriously difficult to diagnose in its early stages because the signs are similar to many other common illnesses. Doctors tend to see large numbers of patients - especially children - with cold and flu-like symptoms, and it's easy to dismiss these as indicating less serious conditions.
A failure to diagnose can have consequences other than the clinical impact on the patient. Because the disease can be so harmful, negligence claims arising from meningitis cases are sometimes extremely expensive. This is particularly true for children, who occasionally need extensive and life-long care.
A failure to diagnose can have consequences other than the clinical impact on the patient
The consequences of a misdiagnosis can also be extremely distressing for the doctor involved. Because the disease is often hard to spot, it can be easy to look back and question your initial judgement if something goes wrong - what did I miss? How could I have done things differently?
Stories in the press involving missed diagnoses can be very high-profile due to the seriousness of the effects and the size of the claims - at £6.8m, one of the largest claims ever settled by the MDU involved a case of meningitis. Along with the responsibility they feel for their patient, this level of attention can be very difficult for a doctor to deal with both personally and professionally.
From reviewing selected settled claims involving meningitis against our members, we can identify some learning points that can help in the defence of a claim.
- Keep full, accurate notes - a clear history and record of your actions helps avoid factual disputes over treatment.
- Be objective - a subjective analysis, such as noting a child 'seems well', can be difficult to prove later on.
- Make sure you have adequate safety-netting - it's vital to have procedures in place if a diagnosis is missed.
This advice doesn't only apply to meningitis cases, and a failure or delay in diagnosing a condition doesn't have to result in a claim of negligence.
Considering the medico-legal consequences of your work is an important step in becoming a doctor, and there are always steps you can take to ensure professional resilience as well as patient safety.
A claim of negligence was brought against an MDU GP member five years after she missed a case of meningitis in a young child. The child recovered after later being taken to hospital for intensive treatment, but unfortunately both feet and the tips of several fingers had to be amputated.
Among the allegations was that if the GP had referred the child to hospital at the outset, treatment would have been administered within 30 minutes and the child would not have suffered any significant injury. The MDU investigated the claim and obtained a number of expert opinions.
The member's legal team advised that the claimant would probably succeed if the case went to trial. All experts agreed that had the child been admitted, it was likely he would have made a complete recovery.
On hearing this advice, the member said that she would prefer the case to be settled and the MDU instructed experts to quantify the claim. The child would remain severely disabled, and it was agreed that he should be provided with a wheelchair and prostheses throughout his adult life and a bungalow with enough space for his mobility needs, as well as physiotherapy and occupational therapy.
It was deemed that the claimant could be employed in the future, but the claim was based on a full loss of earnings and large ongoing care costs - an estimated sum of £5.5 million. After negotiation, the case was settled for £3.5million.