When a nurse arrived at the child's home three hours later, the boy was very ill with marked head retraction and the nurse arranged an urgent admission to hospital where a diagnosis of meningitis was made. Many cases of missed meningitis involve care given by several doctors and the notes have not adequately reflected the previous history and findings, thus contributing to the diagnostic failure. It cannot be stressed too highly how important are good contemporaneous notes in the defence of a claim. Notes should be kept of all consultations and telephone conversations. Where a decision is made not to see a patient, the conversation should be particularly carefully documented.
Many claims become indefensible simply because the notes are inadequate or absent.
One would not wish to encourage lengthy defensive note-keeping but, when a diagnosis of meningitis has been considered, it is wise to record important negative findings. For example, that a check has been made for meningeal signs such as neck stiffness or a positive Kernig's and, in babies, that the fontanelles are normal. In analysing what went wrong with cases that come to medico-legal attention, it is not uncommon to find problems of communication between doctors and parents and, at times, between the various doctors who have been involved. GPs should ensure that their practice arrangements allow for good transfer of information between doctors covering for each other, particularly if deputising services are used. Several doctors in succession seeing the same child over several days will upset the parents' confidence and make it very difficult to detect subtle but significant changes in a child's condition.