Claims insights: otolaryngologists (head and neck surgeons)

Our analysis of claims and complaints shows the main issue for otolaryngologists is about procedural or surgical issues.

Monday, 7 October 2024

Overview

Practice points

More than half of claims and complaints related to procedural/surgical issues. Other concerns involved diagnosis and practitioner behaviour.
The predominant issue was surgical performance, skill or competence, with allegations of poor functional outcome and/or poor appearance as a result.
Another common issue was inappropriate selection of procedure including allegations of unnecessary surgery.
In more than two-thirds of claims and complaints, surgeons were found to have met the standard of care.

Claims and complaints are frequently driven by outcomes that don’t meet patients’ expectations, such as ongoing symptoms, complications or unsatisfactory appearance.
You can better manage patient expectations through good communication, a thorough consent process and by providing examples of realistic results.
Explain alternatives including the option of not operating.
Discuss the possibility that additional surgery (and cost) may be necessary if complications arise or if the procedure does not achieve the expected outcome.
Document your discussions.

Incidence and breakdown by type of matter are based on all matters indemnified by Avant for otolaryngologist members from FY2019–23. Underlying themes and assessment of care are based on Avant claims and complaints closed during the period FY2019–23.

Incidence of medico-legal matters per year for otolaryngologists is 1 in 7.

Avant otolaryngologists had a medico–legal matter raised about the provision of their care, each year. The types of matters included regulatory complaints (53%), claims for compensation (36%), employment disputes (5%) and other matters (7%) (*five-year average).

Main issue addressed in claims and complaints

Main issues addressed in claims and complaints were procedural (52%), practitioner behaviour (13%), diagnosis (13%), consent (9%), management/treatment (9%) and other issues (4%).

Procedural/surgical

The stage of care relating to procedural/surgical claims and complaints was:

29% Pre-operative

The most common allegation was inappropriate procedure or surgical approach (e.g. unnecessary surgery, concerns about procedure that resulted in injury/ongoing symptoms or other adverse events).

64% Intra-operative

Most common allegations were about poor surgical performance:

poor functional outcome (e.g. ongoing symptoms, complications, or adverse events, nerve injury)
poor aesthetic outcome (e.g. nasal deformity, damaged/collapsed septum, issues with alignment and shape).

7% Post-operative

The most common allegation was inadequate post-operative care (e.g. management of post-operative complications or outcomes).

The most common procedures involved in procedural/surgical claims were septoplasty, rhinoplasty, tonsillectomy and adenoidectomy.

Diagnosis and practitioner behaviour

13% of claims and complaints were about diagnostic issues, commonly involving neoplasms. Most of these were from the initial clinical assessment phase and included allegations of inadequate examination or failure to refer for appropriate diagnostic testing.

A similar number of claims and complaints (13%) related to practitioner behaviour with the most common issues about communication and doctor’s health impairment.

Assessment of the care provided

Experts and/or regulators assessed the care provided and found:

68% of otolaryngolist claims met the standard of care while 32% were assessed as below standard.

(% of complaints/claims where the assessment of the expected standards on the main factor is known)

Our data

This retrospective review is of routinely collected and coded data and is based on matters involving Avant otolaryngologist members from across Australia.

Glossary

Matters include claims, complaints, coronial cases and other matters such as employment disputes and Medicare.
Claims refers to claims for money, compensation and civil claims.
Complaints relates to formal complaints to regulators.
Employment disputes are matters where Avant defends members against complaints or supports members to resolve employment issues.
Medicare matters include Medicare investigations and audits.

More information

For medico-legal advice, please contact us here, or call 1800 128 268, 24/7 in emergencies.

For any queries on this analysis, please contact us at research@avant.org.au.

Disclaimers

IMPORTANT: Avant routinely codes information collected in the course of assisting member doctors in medico-legal matters into a standardised, deidentified dataset. This retrospective analysis was conducted using this dataset. The findings represent the experience of these doctors in the period of time specified, which may not reflect the experience of all doctors in Australia. This publication is not comprehensive and does not constitute legal or medical advice. You should seek legal or other professional advice before relying on any content, and practise proper clinical decision-making with regard to the individual circumstances. Persons implementing any recommendations contained in this publication must exercise their own independent skill or judgement or seek appropriate professional advice relevant to their own particular practice. Compliance with any recommendations will not in any way guarantee discharge of the duty of care owed to patients and others coming into contact with the health professional or practice. Avant is not responsible to you or anyone else for any loss suffered in connection with the use of this information. Information is only current at the date initially published. © Avant Mutual Group Limited 2024. Insight-19a Published and current as of: 09/24 (DT-3979)