Mr B was middle-aged and a heavy drinker. His wife called the GP practice, and asked for a doctor to visit her husband, who was complaining of shivering and back pain.
Dr W went to see him and, finding only chest wall tenderness and a normal temperature, diagnosed muscle spasm. She gave him diazepam and dihydrocodeine from her bag and wrote a prescription for an anti-inflammatory.
Three days later, Dr W was called back to see Mr B. He had been drinking and seemed to be anxious.
He was disorientated and hallucinating. Dr W arranged for a psychiatric admission later the same day. A few hours after she left, however, Mr B collapsed. An ambulance was called, but when it arrived the paramedics were unable to detect any vital signs. Mr B was taken to hospital, where he was pronounced dead on arrival. A post-mortem showed confluent bronchopneumonia with plentiful pus on lung section.
A subsequent claim alleged that Dr W had been negligent in failing to examine Mr B properly and, consequently, missing the correct diagnosis and failing to prescribe antibiotics or arrange admission to hospital.
We sought opinions from a GP and a chest physician. The GP expert felt that Dr W’s management on her first visit was reasonable, but that she only carried out a cursory physical examination on the second occasion. Had she examined Mr B more thoroughly, she would have realised that he had a severe chest infection.
The chest physician was a little more sceptical; he thought that physical signs of the chest infection would have been present at the first visit. In any case, a correct diagnosis and appropriate action during either the first or the second visit would probably have saved Mr B’s life.
He commented that ‘Patients known to drink excessive amounts and develop delirium tremens ... are particularly liable to develop bronchopneumonia. This knowledge should alert the prudent practitioner in her management.’
The claim was settled for a large sum to compensate Mr B’s dependent children for the loss of their father’s support.
Intoxicated patients are not easy to deal with, but it’s as well to bear in mind that the effects of alcohol can mask or mimic signs of serious illness. People with chronic drink problems are also more susceptible to certain conditions, as in this case.