Honesty is always the best policy
26 Nov 2021
Case history
The patient attended Dr X to undergo endovenous laser ablation of her varicose veins. Dr X worked at a clinic which provided non-surgical treatment for varicose veins.
The procedure involved introducing a guide wire into the saphenous vein, followed by a catheter inserted over the wire. The catheter allows for the insertion of a laser filament directed to just below where the saphenous vein comes off the femoral vein. After an anaesthetic solution is injected around the saphenous vein, the laser is activated and gradually pulled back along the course of the vein with the heat of the laser cauterising the inside of the vein. Over time, the vein scars and disappears.
Unfortunately, in this case, the catheter and optical fibre were damaged during the procedure. A 9 cm segment of the catheter and a 47 cm length of optical fibre became detached and were retained in the patient’s leg.
Despite being aware of this, Dr X did not inform the patient – either at the time of the procedure or at the post-procedure visit two weeks later.
About a month after the procedure, a 20 cm long thin plastic wire protruded from the patient’s unhealed wound on her leg, and the patient was able to remove 47 cm of the wire from her leg. The patient telephoned Dr X’s rooms, but he did not speak with her that day.
The patient then reported her concerns to her GP who referred her for an ultrasound – this revealed a 9 cm length of tubing still within her calf.
The GP arranged for a radiologist to remove the retained tubing. By that time, the catheter had been in her leg for approximately 40 days.
The patient then returned to see Dr X who apologised, acknowledging that he knew the foreign bodies had been left in situ.
The complaint
Subsequently, the patient made a complaint to the Medical Board who sought an explanation from Dr X. His reasoning was that he considered the patient to be an anxious person and he didn’t want to add to her anxiety by telling her about the foreign body in her leg. He felt it could stay within the scar of the vein for a long time without major problem, according to some studies that had been done on the subject – and hence decided it was best for the patient to hide the incident from her.
In retrospect, he acknowledged it was the wrong decision, and that it would have been easy for him to refer the patient to the local hospital for surgical removal.
The Medical Board obtained an expert opinion which stated that the correct decision would have been to inform the patient immediately of the problem and put in place a plan to correct it – which would include removing the retained material in the most appropriate manner.
The doctor’s deliberate decision not to inform the patient of the retained piece of catheter in her leg was undoubtedly in breach of provisions of the Medical Board’s code of conduct.
The outcome
The Medical Board made a finding of unprofessional professional performance in relation to the damaged catheter.
The Board was more critical of the doctor’s conduct after the event in that he did not advise the patient of what had occurred; make suitable arrangements to investigate and treat the retained length of catheter; or refer the patient to another health practitioner for investigation or treatment. The Board was also critical that the doctor did not speak to the patient himself, even when she rang to report that a length of wire had protruded from her leg.
A finding of professional misconduct was made on the part of the doctor, and he received a reprimand.
Medico-legal issues
When adverse events occur, doctors have a responsibility to be open and honest in their communication with patients; to review what has occurred; and to report appropriately. When something goes wrong, good medical practice involves recognising what has happened and acting immediately to rectify the problem, if possible, including seeking any necessary help and advice.
The patient should be informed as promptly and fully as possible about what happened and the anticipated short-term and long-term consequences.
In this case, the doctor received a more serious sanction than he would have, had he been open and honest with the patient in the first instance.
An adverse event can be a challenging situation for doctors. If you need any advice on such matters, please contact our Medico-legal Advisory Services team for assistance on 1800 011 255.
More Resources
Queensland Civil and Administrative Tribunal
cec.health.nsw.gov.au/__data/assets/pdf_file/0006/618387/teach-back.pdf
MDA National
Risk hotspots for hospital specialists & how to respond when things go wrong
cec.health.nsw.gov.au/__data/assets/pdf_file/0006/618387/teach-back.pdf
Medico-legal feature – Open disclosure
cec.health.nsw.gov.au/__data/assets/pdf_file/0006/618387/teach-back.pdf
Medical Board of Australia
Good medical practice: A code of conduct for doctors in Australia
cec.health.nsw.gov.au/__data/assets/pdf_file/0006/618387/teach-back.pdf
Stay updated with the latest medico-legal content |
Subscribe to MDA National’s biannual Member publication, Defence Update, for the latest medico-legal updates, articles and case studies.
Doctors Let's Talk: Get Yourself A Fricking GP
Get yourself a fricking GP stat! is a conversation with Dr Lam, 2019 RACGP National General Practitioner of the Year, rural GP and GP Anesthetics trainee, that explores the importance of finding your own GP as a Junior Doctor.
25 Oct 2022
Systematic efforts to reduce harms due to prescribed opioids – webinar recording
Efforts are underway across the healthcare system to reduce harms caused by pharmaceutical opioids. This 43-min recording of a live webinar, delivered 11 March 2021, is an opportunity for prescribers to check, and potentially improve, their contribution to these endeavours. Hear from an expert panel about recent opioid reforms by the Therapeutic Goods Administration and changes to the Pharmaceutical Benefits Scheme.
14 May 2021
Diplomacy in a hierarchy: tips for approaching a difficult conversation
Have you found yourself wondering how to broach a tough topic of conversation? It can be challenging to effectively navigate a disagreement with a co-worker, especially if they're 'above' you; however, it's vital for positive team dynamics and safe patient care. In this recording of a live webinar you'll have the opportunity to learn from colleagues' experiences around difficult discussions and hear from a diverse panel moderated by Dr Kiely Kim (medico-legal adviser and general practitioner). Recorded live on 2 September 2020.
05 Oct 2020
