The reasons patients sue their urologist
Dr Shabbir Choudhury, medico-legal adviser and former senior medical claims handler at the Medical Defence Union, analyses clinical negligence claims affecting urologists and provides advice on managing risk.
This analysis of urology claims looks at clinical negligence claims arising out of our urology members’ private practice.
I examine the trends observed over a recent ten-year period, the reasons for litigation and risk factors that might reduce the chance of a claim being made in future.
Over the decade, the frequency of claim notifications initially rose to a peak in 2015, but has slowly reduced since then. More than 75% of claims opened in the period have been successfully defended and closed with no payment of compensation or claimant costs.
Almost half of the settled claims cost the MDU over £100k each to settle. But remember that the level of compensation paid in clinical negligence claims bears little or no relation to the seriousness of the allegations, but reflects the cost of restoring the claimant to a position they would have been in had the negligence not occurred.
However, this does demonstrate the need for urologists to have appropriate indemnity arrangements in place, as even lower-value claims can settle for damages and costs that are beyond the means of most members to pay.
What are the reasons for claims involving urologists?
Poor outcome/complications after surgery
The single largest reason for urology claims is due to allegations concerning unintended consequences of surgery.
The commonest of these, in order of occurrence, were:
Infection;
Renal damage;
Incontinence and erectile dysfunction;
Bladder or bowel perforation;
Retained foreign bodies.
Delayed diagnosis of cancer
The second largest reason for urology claims was an allegation of delayed diagnosis and that, had certain investigations or actions been carried out, the patient would have been diagnosed with cancer sooner, which would allow for either an effective cure or would have improved prognosis.
Failure to obtain consent
The third most common reason for claims were allegations around the consent procedure and whether the surgeon had adequately explained the risk of the procedure.
It was alleged that this had an impact on whether the patient would have chosen not to undergo the treatment or may have done so at a later time.
Managing risks
Claims involving urologists often focus on a few key areas, such as the surgical technique being inadequate, investigations not being performed early enough or a lack of communication skills, which resulted in inadequate consent being taken.
However, there are ways to reduce risk and, in turn, the likelihood of a claim, which include:
Ensure robust procedures are in place for communicating results to the relevant parties to ensure appropriate and prompt follow-up and treatment.
Be aware of the GMC’s guidance on consent and other relevant guidance such as those of NICE.
Consent should be obtained by an appropriate member of the team and, ideally, by the urologist undertaking the procedure.
Ensure that the patient is aware of the risks, benefits and complications of the procedure as well as other therapeutic options.
Discuss these options in a way the patient can understand, avoiding medical jargon wherever possible. Document this carefully.
Supporting information such as patient leaflets and information sheets can help patient understanding.
The use of these should be documented in the records.
Check that the patient understands the procedure you propose to undertake and is aware of the possible complications.
If things go wrong, be open and honest with the patient and provide an explanation of what has happened and the likely short- and long-term effects of this.
Say sorry and get advice from your medical defence organisation if you believe the incident triggers your ‘duty of candour’ requirement.
If there is a time lag between consent being obtained and the procedure being carried out, it is important to ensure that the patient still consents to the appropriate procedure and it is still appropriate.
The surgeon carrying out the procedure needs to ensure that he or she is adequately trained and experienced in undertaking it.
Ensure that good records are kept throughout and procedures audited for both outcomes and complications.
Offer a chaperone to patients undergoing any intimate examinations.
Have a system in place to verify the right site and patient undergoing treatment and to cross-check information provided against the referral.
It can be very distressing to find out a patient is bringing a claim against you.
The MDU understands how stressful this is and will defend claims whenever possible.
It is also campaigning to reform the legal environment surrounding compensation payments.
To learn more, visit www.themdu.com/faircomp
