Login

Communicating a decision not to perform a procedure

Summary: Doctors are not obliged to provide care that is not clinically indicated. However, as this case illustrates, it is important to take care if you are declining to treat, as patients can be unhappy and complain about your decision.

Monday, 13 March 2023

Key messages from the case

Doctors are not obliged to provide care that is not clinically indicated. However, as this case illustrates, it is important to take care if you are declining to treat, as patients can be unhappy and complain about your decision.

Details of the decision

Clinical care and decision not to treat

A patient was referred to an ENT specialist after three episodes of tonsillitis in the previous nine months-each taking longer to resolve than the last and required antibiotics. The patient requested a tonsillectomy.

According to the relevant state’s referral guidelines, tonsillectomy was not clinically indicated based on this history. On examination the patient’s tonsils were moderately large but not infected.

The doctor outlined the procedure and explained the risks and potential complications. He also explained that a tonsillectomy was not clinically indicated at that time and what the criteria for tonsillectomy would be.

The doctor developed an appropriate treatment plan to manage the patient conservatively and advised the patient that if he continued to experience episodes of tonsillitis he could return for review and re-assessment of whether the procedure had become clinically indicated.

The patient was dissatisfied and complained to the regulator.

Medical records

The doctor had made very detailed notes covering:

  • the clinical basis for his treatment plan and decision to adopt a wait-and-see approach, in line with accepted clinical guidelines; and
  • the discussion with the patient as to why the procedure was not clinically indicated.

Outcome

No further action.

Key lessons

Your professional obligation to ensure the services you provide are clinically necessary and likely to benefit the patient means you should not perform a procedure you do not consider is clinically indicated.

If you decline to perform a procedure, it is important to clearly communicate your reasoning to the patient and take extra time to document the discussion carefully – particularly if you believe the patient is unhappy about the decision.

Ensure you refer to any applicable guidelines, second opinions or tests that formed part of your clinical decision-making.

Make sure that you explain any eligibility criteria and how to return for review if appropriate. Consider suggesting the patient obtain a second opinion from another specialist if they seem dissatisfied with your proposed treatment plan.

References and further reading

For more information or immediate medico-legal advice, call us on 1800 128 268, 24/7 in emergencies.

Download case study

Communicating a decision not to perform a procedure (PDF)

Disclaimers

Scenarios in this publication are based on Avant claims experience to date. Certain information has been de-identified to preserve privacy and confidentiality. 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 2022 riskiqcase-261 03/23 (DT-2913)

To Top