A Case Example
In this case, the patient underwent radiotherapy treatment for a basal cell carcinoma on the forehead after an initial surgical procedure. Following the treatment, the patient was unhappy with the resultant cosmetic appearance; and was left with an overall marred appearance. The patient was initially seen by a plastic surgeon in one clinic and then referred to an oncologist and radiologist in a separate hospital regarding this.
Main Learning Points
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As in many medico-legal cases, this case arises from alleged failures during the consent procedure to fully explain possible adverse outcomes of a particular treatment, including, cosmetic appearance.
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This case demonstrates good practice, however, as the clinician had sufficiently detailed written records of the consent procedure to refute the claims.
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The clinician had notes detailing that the effects of both surgery and radiotherapy had been discussed and that he had advised both methods would deal equally with the cancer. The difference would be in the resultant cosmetic appearance and, that in fact, there could potentially be a worse cosmetic outcome if surgery were undertaken instead of radiotherapy.
- Both radiotherapy and surgical excision with a skin graft have adverse cosmetic outcomes and are appropriate choices to offer a patient with a basal cell carcinoma, which is of course, potentially life-threatening.
Reducing the Risk of Litigation
The clinician was able to refute the claims because he had sufficient written records detailing what had been discussed during the consent procedure.
TMLEP recommends the following:
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When undertaking the Consent process for surgery or other medical procedures, it is essential that detailed notes are taken so that no doubt exists as to what was discussed.
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All viable alternatives to surgery, including no treatment, should be considered and explained clearly, so that a layperson understands the risks, potential adverse outcomes and side effects of any given procedure.
- Ultimately, it is the patient’s choice whether to undertake any particular procedure. As long as they are able to make an informed choice and are aware of the pros and cons of the procedure and any alternatives, this will reduce the risk of litigation for the clinician.
Conclusions
The clinician was able to refute the claims owing to the fact that the detailed notes of the consent procedure showed that he had discussed the option of further surgery and/or radiotherapy and that adverse cosmetic outcomes were possible with both methods. The low risk of radiation-induced cancer meant that the cosmetic outcome was the more significant factor in this case.