...while I'm here, Doctor...
Must I sign peanut allergy protocol for a patient's school?
I have been asked by the mother of a child who has suffered from an anaphylactic reaction in the past to sign a school treatment form giving advice on allergy to peanuts. It appears to be an official hospital form with accurate advice on emergency treatment, but it has been filled in by the mother and includes the use of a homoeopathic preparation (Apis) that I am unfamiliar with. Should I sign?
If you sign the form you would effectively be authorising and taking professional responsibility for treatment you do not understand and that may not accord with hospital recommendations.
We would advise you to sign the form with a simple statement confirming the child does indeed suffer from a severe allergy and that the use of adrenaline as described on the form would be appropriate in an emergency situation.
Most schools insist on similar procedures to ensure the child does indeed suffer from a serious allergy and that emergency treatment could be lifesaving.
It is, therefore, essential to comply with the school protocol which permits prompt treatment in an emergency, as this is in the best interests of your patient and in line with your responsibilities as the child's doctor.
You should not authorise alternative medications with which you are unfamiliar, and which would almost certainly not be authorised by the hospital, as you would be legally and professionally responsible for any adverse consequences.
We have checked with the hospital department that would have initiated this child's treatment. They confirmed categorically that they would never prescribe or authorise the inclusion of Apis on an emergency treatment form.
The specialist clinic undertakes regular training of families and school nurses in the emergency treatment of anaphylaxis. They use an emergency advice sheet, which the clinic doctors sign for use by patients currently under their care. They have agreed to share their currently revised and approved allergy and anaphylaxis advice sheet with you and with any other GPs who may require it at this time.
Obviously you should satisfy yourself it is still correct when you issue it and that you would be prepared to authorise the treatment described.
We are very grateful to Professor John Warner and Dr John Hourihane from the infection, inflammation and repair division of the Wellcome Trust clinical research facility at Southampton University Hospitals NHS Trust for sharing this advice sheet with us.
Dr Christine Dewbury, Wessex LMCs
Neither Pulse nor Wessex LMCs can accept any legal liability in respect of the answers given. Readers should seek independent advice before acting on the information concerned.