The Ebola outbreak in western Africa has claimed thousands of lives. Although it is highly unlikely GPs in the UK will encounter a case of Ebola, the frightening nature of the disease, its high mortality rate and its rapid spread make it important for practices to be prepared.
This includes understanding the ethical and medico-legal implications identified in the following five tips for managing suspected cases of Ebola.
1. Know when to consider the possibility of Ebola infection
Early diagnosis of Ebola is vital because prompt medical care improves the patient's chances of survival and enables effective controls to be put in place to protect the public.
Diagnosis can only be confirmed by laboratory testing, but you and the practice team should know the right questions to ask patients about their recent travel history and symptoms, so suspected cases can be identified and managed.
GPs are not expected to physically examine or treat patients with suspected Ebola, but it is important to be aware of its typical signs and symptoms, which include sudden onset of fever, intense weakness, muscle pain, headache and sore throat.
The GMC recently reminded doctors of their 'duty to ensure patients have access to appropriate care'.1 This requires familiarity with guidance and other information from authoritative sources.
Guidance on steps you should take if a patient with suspected Ebola makes contact by telephone or in person has been published by the UK public health bodies (see box).
The RCGP has also produced step-by-step advice for the practice team, including telephone receptionists, practice managers and clinicians.2
2. Follow rigorous infection control procedures
If a patient poses a health risk, the GMC expects you to 'take all available steps to minimise the risk before providing treatment or making other suitable alternative arrangements for providing treatment'.1
Those in a management role in the practice should 'ensure staff have the necessary equipment and the right information to treat patients while minimising the risk to themselves'.1
Practical advice is available from local public health bodies about:
- Isolating suspected Ebola cases
- Ensuring the room used for them is not accessed until a test result is known (can take up to 12 hours)
- Hand hygiene
- Decontamination of premises
3. Ensure you maintain patient confidentiality
Public concern about Ebola means there is likely to be intense interest in any suspected cases, particularly from journalists, but also from other patients who are concerned about the potential risk.
All patients are entitled to expect confidentiality, but if you find yourself under siege, it may be necessary to issue a limited response.
This should not disclose any personal information which could lead to identification of the patient, but you could set out the infection control measures the practice has taken to protect the public.
If you are considering making a public statement, discuss this with your medical defence organisation or local area team.
4. Communicate effectively
Ensuring patients are urgently and safely transferred to hospital requires clear and accurate communication with the ambulance service and the hospital admissions team, so they can take suitable precautions, for example, in the provision of personal protective equipment.
Paragraph 44 of the GMC's Good Medical Practice says doctors 'must contribute to the safe transfer of patients between healthcare providers and between health and social care providers' by sharing all relevant information to ensure continuity and co-ordination of care.
Good communication is needed to engage with patients and encourage co-operation. For example, Public Health England has told surgeries to display information requesting patients to tell the receptionist on arrival if they are unwell and have returned from an Ebola-affected area within the past 21 days. You could also consider posting information on your website.
Finally, you should ensure that patients who plan to visit a country where there has been an Ebola outbreak receive appropriate advice.
5. Check indemnity cover before working overseas
If you are considering volunteering to work in an Ebola-affected area, contact your medical defence organisation before travelling, with the dates and details of the work you intend to do, to see if it can offer you indemnity.
UK-Med, a charity co-ordinating medical volunteers from the NHS, has published information, including FAQs, on its website (uk-med. humanities.manchester.ac.uk/).
1. GMC. Ebola advice for doctors. www.gmc-uk.org/guidance/25793.asp
2. RCGP. Ebola resources. www.rcgp.org.uk/ clinical-and-research/clinical-resources/ebola.aspx