The hazards of foreign travel

A patient who had just returned from a holiday in Africa attended her GP practice immediately she arrived home as she had suffered a spider bite on her leg while away. The doctor she had seen while abroad had prescribed antibiotics and anti-inflammatories.
The GP was sufficiently concerned to ring the local consultant in infectious diseases who advised that there was no specific treatment for the spider bite.
The GP also examined the patient’s leg, specifically looking for signs of a deep vein thrombosis (DVT) in view of the long journey the patient had undertaken. She found none but she did observe cellulitis and generalised oedema of the lower leg. She also established that the patient had taken the anti-malarials she had been prescribed prior to travel.
As there was no fever and no other systemic symptoms at the time, the GP advised review in one week or earlier if the condition of the leg deteriorated.
Two days later, as the swelling was worse and the leg more painful, the patient arranged to see an out-of-hours doctor who referred her to hospital, where a DVT in the leg was diagnosed. The patient was given anticoagulants and discharged.
A claim was made against the GP, an MDU member, alleging delay in the diagnosis of the DVT.

How the MDU responded

A consultant in infectious diseases said that the relevance of the bite to the DVT was difficult to comment upon as significant tissue swelling can follow spider bites. He said that although venous thrombosis is associated with spider bites in very rare cases, the association is not clear and only a venom specialist could be sure. The air travel was probably much more significant a factor, he concluded.
In the event, the claim was not pursued against the GP, possibly because the claimant was advised that the short delay in the diagnosis of the DVT had not caused any harm.

Learning points

  • With patients travelling to more exotic places, doctors will probably wish to consider the possibility of tropical diseases and ensure, as in this case, they are excluded. If necessary, GPs may need to seek the advice of more experienced colleagues, such as a consultant in tropical medicine.
  • The GP gave the patient clear advice about what to do if their condition didn't improve. The GMC requires doctors in Seeking Patients' Consent (1998) to tell patients " how and when [their] condition and any side effects will be monitored or reassessed" (paragraph 5).
  • The GP had kept clear, accurate and contemporaneous notes. She had recorded in detail the differential diagnosis, the examinations that had taken place, and themanagement plan, including the advice given to the patient about follow up. The GP would have been able to rely on the records in defending the claim.

This page was correct at publication on 01/12/2007. Any guidance is intended as general guidance for members only. If you are a member and need specific advice relating to your own circumstances, please contact one of our advisers.