Surgeon pulled up for poor communication

As a medical specialist, it's common for you to see many patients requiring the same treatment. This may mean you sometimes forget that, while you're very familiar with the possible adverse events relating to treatment, your patients are not and are often overwhelmed by the situation they find themselves in. 

Background to the case

In this case, a patient was referred to a urologist for management of prostate cancer.

The urologist recommended neoadjuvant hormone therapy and radiation therapy as an appropriate treatment given the patient’s age. Following the treatment, the patient developed significant urinary tract symptoms and night-time urination. These are recognised side effects of the treatment, of which the surgeon believes he informed the patient. To alleviate the patient’s significant urinary symptoms, a steam prostatectomy was performed. This resulted in bladder spasms and pain for which trans-urethral resection of the prostate was recommended.

Patient unhappy with treatment outcome

Unfortunately, this treatment resulted in incontinence and pain post-operatively. Again, these are recognised complications of which the patient was advised. Understandably, the patient was very unhappy with the outcome.

The patient made a notification to Ahpra alleging the clinical treatment provided to him by the urologist was inappropriate. In addition, he claimed the urologist did not adequately explain the risks associated with the procedures he performed, and was rude, dismissive and lacked empathy in his communications.

Management appropriate, but communication was not

Ultimately, the Medical Board accepted that the management recommended by the urologist was reasonable. However, it was determined that the clinical records did not assure the board that appropriate informed consent was sought from the patient, or that the urologist communicated with the patient in an effective and empathetic manner.

Regulatory action proposed

The board proposed regulatory action in the form of one-on-one education around communicating with patients and informed consent.

Avant assisted the urologist in proactive completion of education, including one-on-one mentoring.

Ultimately, no further action was taken.

The case is a reminder that as a medical practitioner, it is essential to maintain good medical records, especially to capture your discussions around consent, as well as risk and complications of the proposed treatment. Our Risk Advisory Service can assist in creating a comprehensive consent form.

If a patient attends to discuss their concerns, it is also worth noting in the records what those concerns were and that they were addressed appropriately and with empathy.

Doctor-patient communication a common issue

The complaint notification to Ahpra in this case could likely have been avoided if the doctor had communicated better with his patient. 

This is a common issue, with our analysis showing 4 in 10 complaints and compensation claims involved doctor-patient communication as either a primary or secondary allegation. The content of the communication (or lack thereof) was the most common concern raised, followed by the manner of communication.

Data source: claims and complaints involving communication issues closed 2017-18 to 2021-22.

Complaints involving communication issues

Content issues

Manner issues

Key points

• Content and manner were the two main issues in claims and complaints about doctor-patient communication.
• Lack of information provided was the most common allegation about the content communicated.
• Inappropriate manner of communication and lack of empathy were the key allegations regarding manner of communication.
• Perception of lack of care or consideration for the patient underlies many allegations about the manner of communication.
• One in five communication-related allegations was assessed not to meet the standard of care.

This article was originally published in Connect magazine issue 23.

Resources

Avant article – Connecting with patients

Claims insights – Doctor-patient communication

More information

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