Miss T suffered from schizophrenia and lived in a hostel near Dr U’s surgery in Africa. She had been generally unwell for two months and visited Dr U on several occasions.
One day, a care worker from the hostel telephoned the surgery and told the practice nurse that she was worried about Miss T, who had been complaining of an upset stomach, weight loss, generalised weakness and excessive thirst. Miss T visited the surgery later that day and Dr U took blood for haemoglobin levels and a stool sample to be tested for hookworm.
Three days later, the staff at the hostel were still concerned about Miss T’s state of health and they asked Dr U to come and see her. Dr U attended and recommended that Miss T be taken to the emergency psychiatric clinic, as it was his opinion that her symptoms were psychosomatic in origin.
Miss T arrived at the psychiatric clinic later that day. She was seen by a junior doctor, who arranged an immediate transfer to the emergency department. By the time Miss T arrived at the hospital she was unrousable. The notes recorded a pulse rate of 101 bpm, BM stix Hi-Hi, respiratory rate of 32 and ++ ketones in the urine.
Attempts to stabilise her were unsuccessful; eight days later, Miss T suffered a cardiac arrest and died.
A claim was brought against Dr U, alleging that Miss T had presented with classic symptoms of diabetes mellitus and that Dr U should have considered this as a differential diagnosis.
The question of whether Dr U delivered a sub-standard level of care hinged upon his visit to Miss T at her hostel.
The GP expert we consulted felt that he had not examined her thoroughly enough. It was more than likely that ‘her symptoms and physical signs, at this time, were compatible with a diagnosis of acute diabetes mellitus. That being the case, the more appropriate referral would have been to a general medical bed.’
He concluded that Dr U would be vulnerable to a finding of breach of duty based on his management of Miss T at that time. We therefore decided to seek a settlement to the case.
Patients with longstanding chronic conditions do also develop new disorders. These may often be masked by the existing condition, which makes it difficult to recognise them.
Particularly vulnerable are patients with mental health problems and prisoners. While it is true that new symptoms in such patients can often be manifestations of psychological problems or manipulation, no such conclusions should be drawn until adequate steps have been taken to exclude an organic cause.
See the Royal College of Psychiatry’s 2001 report, Mental Illness: Stigmatisation and Discrimination Within the Medical Profession.