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Inappropriate advice

01 November 2005

Mrs G, a 50-year-old baker, became unwell with what appeared to be flu. There was an outbreak of flu in the area at the time. Mrs G telephoned her GP surgery and spoke to a receptionist who told her to take bed rest, plenty of fluids and paracetamol.

By the next day Mrs G was feeling worse. She had a headache and appeared to her daughter to be confused. Mrs G’s daughter telephoned the GP surgery and spoke to a receptionist who said that Mrs G was suffering from flu and didn’t need to see a doctor.

Mrs G attended her local emergency department two days later, complaining of left-sided chest pain. She was apyrexial with a tachycardia and there were no significant signs in her chest. A CXR showed left-sided consolidation and pneumonia was diagnosed. Her blood tests showed leucopenia and significant metabolic derangement as a result of her infection. Mrs G was treated with intravenous fluids and antibiotics.

Despite receiving optimal therapy, she continued to deteriorate and died five days after admission.

Mrs G’s daughter sued the partners at her mother’s GP practice, alleging that they had been negligent in allowing a receptionist to twice refuse a home visit and offer advice without medical assessment or input. It was alleged that had Mrs G been seen when requested, then earlier treatment or hospital admission would have saved her life.

Expert opinion

We asked a GP expert to examine the details of the case. The expert felt that the initial advice given by the receptionist would have been appropriate, in the middle of a flu outbreak, but was uncertain as to what had actually transpired, as the call had lasted for less than a minute and no significant details were logged.

The expert felt that when Mrs G’s daughter had telephoned for further advice, in the context of a patient who was apparently confused and deteriorating, it was inappropriate for the receptionist to give any advice without asking a doctor’s opinion. It was difficult to know what was actually said during the conversation as, again, the log of the call included few details.

An expert respiratory physician commented that it was likely that if Mrs G had been admitted to hospital after the second alleged request for a visit, she would have survived. As regards Dr P’s treatment, it was felt that amoxicillin was an appropriate antibiotic to treat a community-acquired pneumonia. By the time she received this therapy, the expert thought it likely that the leucopenia and metabolic derangement were already present and that Mrs G’s deterioration was inevitable.

The case was settled for a sum equivalent to £70,000 (US$125,000). It would have been difficult to defend the case in the view of the expert opinions, without evidence that the substance of the telephone calls differed significantly from Mrs G’s daughter’s account. 

Learning points

  • Telephone advice can be an acceptable method for managing patients, particularly during community outbreaks of disease. However, it should be delivered by appropriately trained healthcare professionals and be backed up by an explicit protocol that should include follow-up arrangements.
  • There should be a cautionary approach with a bias towards face-to-face assessment where there is any potential cause for concern. Where non-healthcare staff are expected to give general advice, this is even more essential, and any protocol should have built-in provisos on medical input. Call logs should record the pertinent details.
  • Community management of respiratory illness. The Scottish Intercollegiate Guidelines Network has guidelines on Community Management of Lower Respiratory Tract Infection in Adults available here. Section 3, Assessment of Severity, is particularly pertinent to the issues raised by this case. 
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