This case that I am posting in our Forum is not something that happened in some third world country but in UK – a country where health care is considered to be of a very high standard.

Mrs B a 27 year old secretary had just returned from a holiday in Pakistan. Three days after returning had profuse diarrhoea ( 7 times that day) that she went to see her doctor. Dr A noted that her BP, pulse and temperature were normal and her abdomen was soft and non tender. He then prescribed her paracetamol and co-phenotrope (Lomotil) and told her to come back if there was no improvement.

Mrs B waited for a week and as there was no improvement, she feeling nauseous and weak with persistent diarrhoea she returned to her doctor. Dr A saw her again and noted – persistent diarrhoea, BP and Pulse normal, Abdomen soft. This time he prescribed codeine linctus and loperamide.

Two days later as she began to feel even weaker with persistent diarrhoea her mother-in law became worried and made an urgent appointment to see her doctor again. This time her doctor found her restless and sweating with a tender abdomen. He got her admitted to hospital with a possible diagnosis of enteritis or malaria.

At the hospital blood smear, blood cultures and stool culture were done. She was then started on IV fluids and oral ciprofloxacin. Early report on the blood culture indicated gram negative rod likely to be salmonella. Microbiologist suggested continuing with ciprofloxin. After two days of treatment oral ciprofloxcin was switched to IV cipro as patient was nauseous and refused to take it orally. The following day she had a cardiac arrest and died inspite of attempts at cardiac resuscitation .

Patient’s family sued the doctor. They said that she would not have died if her doctor had investigated her symptoms promptly.

The expert who reviewed and reported on the case was not critical of the doctor’s 1st consultation. He said many patients who go on holidays come back with traveller’s diarrhoea and as the symptoms exhibited were only 2 days old, the treatment that was prescribed was adequate. Investigation for a two day old diarrhoea was rarely called for and antibiotics were not routinely prescribed. However he was very critical of the doctor for the way he had responded when the patient returned having had the diarrhoea for over 10 days. He also said that the doctor’s notes were very brief, he had not recorded the presence or absence of blood in the stool or abdominal pain. The ongoing condition required the identification of the causative organism and he should have done a stool culture.

The case was settled for a moderate sum.

Badri.

( The case was reported in “Case Book” of the Medical Protection Society volume 23 issue 2)