Readers may remember the tragic story story of 1 year old William Mead who died from sepsis and whom I wrote about last month. His mother, Melissa, recently met with the UK Health Secretary, Jeremy Hunt, and according to press reports he appears close to announcing a campaign to improve the awareness of sepsis among providers.
I always struggle with the wisdom of single disease awareness campaigns as they seem to me to be a zero sum game and, in some cases, could cause more harm than good. The campaign started many years ago, to improve awareness of meningitis, is held up as one of the most successful disease awareness campaigns. Many parents will now know to look out for a non blanching rash and/or photophobia.
Melissa Mead told the Press Association: “If our doctors aren't recognising sepsis how are parents supposed to recognise it? That is something I want to raise - how to we get that out there?
"It needs to be in packs which are given to first time parents, it needs to be on TV like the Fast stroke campaign and the meningitis campaign, it needs to be out there for the general public to grasp.
"When I called 111 I didn't know that William was seriously ill, I didn't collectively look at William's symptoms and think 'this is sepsis' because I didn't know what sepsis was.
"I was checking for rashes all over William because I knew what meningitis was but I didn't know what sepsis was."
The most interesting quote is the last one stating how she knew what to look for with meningitis but didn’t know about sepsis. Two questions come to my mind:
- The first is there are thousands diseases out there so how many can and should parents realistically be aware of and effectively be able to diagnose?
- Second, did the fact that she knew about meningitis and then correctly ruled it out mean that it gave her a false sense of security as she wasn’t aware of all the other possible diagnoses?
I have often wondered whether a successful disease awareness campaign, such as meningitis one, could actually cause more mis- or delayed diagnosis as it effectively biases peoples thinking.
In the absence of any meaningful changes, a sepsis awareness campaign would be better than nothing. But it shows really poor clinical skills if a clinician cannot recognise when somebody, especially a child is seriously ill. However, recall that sepsis is basically what happens when the diagnosis of what you actually had to start with is delayed. To get to the stage where you have sepsis means that the health system failed you and the clinicians you went to previously failed to make the medical diagnosis of what you first complained of. The real solution that the UK Health Secretary needs to find is how to improve the quality of diagnosis decision making across the whole of the health system.