CASE FILES COMPLAINT NOROVIRUS DIFFERENTIAL


BACKGROUND A locum GP – Dr R – is working at a practice after hours. A call comes in on his mobile from the mother of a 19-year-old patient – Joe – who is suffering with severe vomiting. The signal on the phone is poor and the GP has difficulty spelling the patient’s surname in order to locate his file on the practice system. There has been an outbreak of norovirus


at Joe’s college and his mother is very worried as he has not been able to keep down any fluids for the last 24 hours. Dr R agrees to visit the patient at home and finds him quite ill and distressed. His pulse rate is slightly elevated and blood pressure is 120/70. His abdomen is non-tender and there is no sign of peritonitis. The GP diagnoses norovirus and is


concerned that the patient does not become further dehydrated. An anti- emetic injection is administered and the mother is advised to contact the practice again if Joe’s condition does not improve. Later that night Joe loses consciousness


and his mother phones an ambulance. Paramedics check his blood sugar which is 36 mmol/l. Joe is taken to hospital and diagnosed with diabetic ketoacidosis (DKA). He spends two days in the ITU and is released a few days later with a referral to a diabetic clinic. A week later Joe’s mother writes a letter


of complaint to the practice in regard to Dr R’s treatment of her son. She alleges that he was rude and impatient on the phone, claiming that he could find no record of her son in the files though he has been a patient at the practice since he was a child. She also accuses the GP of disregarding her concerns over the seriousness of her son’s illness and putting his life at risk by misdiagnosing a serious condition.


ANALYSIS/OUTCOME Dr R is upset and regretful at his failure to diagnose Joe’s condition and the practice asks MDDUS for help in composing a response. First, the practice is urged to contact Joe for consent to allow his mother to deal with the matter, and then to offer a meeting to discuss the complaint if desired. In the written response, Dr R first


expresses his regret for what Joe has been through and that this has prompted the complaint. He is also sorry that the communication difficulty in the initial telephone contact had been perceived as rudeness by Joe’s mother and that his manner seemed dismissive during the home visit. It was certainly not his intention. He explains that the symptoms and Joe’s exposure to the outbreak at the college all


18 / MDDUS INSIGHT / Q2 2017


KEY POINTS ●A sincere expression of regret can do much to defuse an angry complaint. ●Recognise the potential for misunderstanding in non-face-to-face patient contact. ●Positive reflection on how risks can be prevented in future are often all that complainants want.


suggested norovirus. DKA would not have been an obvious diagnosis given the circumstances. Dr R also states that he has reflected on


his practice and manner of communication, and in future will be more mindful of the possibility of diabetes and consider a finger-prick glucose check in similar circumstances. Nothing is heard back from the family and they remain registered with the practice.


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