Sepsis the silent killer - the importance of obtaining a subjective patient history

By Alexandra Winch and Nivetha Ramachandran, Medical Negligence solicitors at Irwin Mitchell

Every hour, five people die of sepsis in the UK. That’s at least 48,000 every year. The numbers are staggering. 

Sepsis does not discriminate and it can affect anyone at any age with no history of illness or surgery. 

Early diagnosis and treatment is the key to reducing the number of fatalities but the difficulty is that the initial symptoms are often misinterpreted for illnesses such as the flu or a chest infection.

Raising awareness of sepsis

As medical negligence solicitors, sadly we have acted for a number of families who have been left devastated by the loss of their loved one as a consequence of the failure to diagnose sepsis. 

It is of vital importance that we raise awareness of these issues and learn from past experiences to prevent the same mistakes being repeated. 

If we can all share experiences and help to raise awareness of the symptoms then we can work together to reduce those staggering numbers.

The signs of sepsis

The UK Sepsis Trust advises that symptoms of sepsis in adults can include:

• S – Slurred speech and decreased mental ability / confusion
• E – Extreme shivering, chills or muscle pain
• P – Passing no urine (in a day)
• S – Severe breathlessness or fast heart rate
• I – It feels like “I’m going to die”
• S – Skin is mottled or discoloured

Review of cases highlights common trend

We undertook a review of three cases where we have acted for families who have lost a loved one to sepsis in order to identify any common themes. 

It really struck us that in all three cases, although their symptoms varied, the families described their loved one falling extremely ill over a short period of time. 

Most significantly the families recall their loved one complaining that they felt so ill, they thought they were going to die. In all three cases, this history was not elicited by the medical practitioner and is not recorded in the records. 

All of the patients were previously fit and healthy, middle aged with no significant past medical history – yet they felt so ill, they told their family they thought they were going to die. This is a common symptom of sepsis that all medical practitioners should be aware of when taking a history of the symptoms from the patient.

In one case, the husband of the patient was speaking to the GP on her behalf because she was so unwell and weak. The patient was normally extremely talkative and so her presentation was completely out of character. However, the medical practitioner failed to note that this was of any significance and did not ask any questions to elicit why her husband was speaking on her behalf.

In another case, the patient was incorrectly diagnosed with a muscle sprain having presented to her GP with a red and inflamed rash under her right arm which was extremely painful. The medical practitioner failed to elicit that she also felt extremely unwell and suffered with vomiting, nausea and fever. Had this history been obtained, the medical practitioner would have considered alternative diagnoses leading to further investigations.

The need for doctors to take a subjective medical history

The significant importance of taking a detailed and subjective history from the patient and family members in attendance cannot be undermined, particularly because not all patients will have any abnormal objective vital signs such as a fast heart rate. 

The common theme identified in all of the cases reviewed was a lack of adequate questioning and consideration of the patient’s subjective presentation, in order to determine the severity of their illness and any changes to normal behaviour.  

Sepsis requires urgent medical care and it is key that any abnormal characteristics are considered as part of any patient review to assist in ensuring an earlier diagnosis. If in any doubt, the question must always be asked – could this be sepsis ?

Find out more about Irwin Mitchell's expertise in supporting patients and families affected by the condition at our dedicated sepsis section. 

The common theme identified in all of the cases reviewed was a lack of adequate questioning and consideration of the patient’s subjective presentation, in order to determine the severity of their illness and any changes to normal behaviour.”