Why Patient Awareness of the Possible Adverse Effects of Surgery and Radiotherapy is so Important

Introduction

Medical research group TMLEP recently analysed the importance of sound consulting practice, including maintaining written records for surgical and radiotherapy patients. According to their report, the investigation came about as a result of a complaint received following radiation treatment and surgery.

After a surgical operation and radiation treatment for a forehead basal cell carcinoma. the patient concerned considered the resulting appearance to be unsatisfactory. Consequently, a separate consultation took place with an oncologist and radiologist in a different hospital.

Main findings

Investigators noted that the patient’s counsel alleged failures associated with obtaining proper consent, not uncommon in this type of medico-legal case. Specifically, allegations suggested insufficient explanation of the potentially adverse results.

Nonetheless, during the initial consultation in the first clinic, the plastic surgeon had maintained detailed records. According to the hospital notes, the patient consented and was fully aware of the possible side effects of cancer surgery and radiotherapy.

Additionally, the medical professional had taken care to explain the necessity for the dual-pronged approach to treat the cancer. Cosmetic appearance considerations formed part of advice given, along with the possibility of a worse outcome if opting only for surgery, i.e., excluding radiotherapy. Consequently, evidence of good practice was apparent.

The clinician’s legal defence duly opposed the claim, arguing that the standard treatment for patients with this type of skin cancer included radiotherapy, surgical excision and a skin graft. Furthermore, although lifesaving, such interventions do tend to cause some disfigurement.

Minimising the risk of litigation

In this instance, the clinician successfully refuted the claim for compensation because he had obtained informed patient consent and kept appropriate records.

Accordingly, the panel recommended that:
• During consultations for surgery and other medical interventions, it is essential to take comprehensive notes regarding the topics discussed and patients’ consent.
• Healthcare professionals should consider and explain all the feasible and practical alternatives to surgery – including no treatment at all. Consequently, an informed layperson ought to be able to understand the risks, secondary effects and potential adverse outcomes.

In the end, the choice of whether to agree to an elective medical procedure lies with the patient. Providing he or she can make a fully informed choice and is aware of the advantages and disadvantages of the intervention as well as alternatives, the clinician involved should be at less risk of future legislation.

Summary

In this case, the surgeon refuted the patient’s litigious claims, producing copies of detailed consultation notes and confirmation of informed consent. Specifically, the doctor and patient had discussed the treatment options and risks of surgery with or without radiotherapy, in addition to the likelihood that typically, both approaches have negative cosmetic outcomes.

As a final observation, investigators deemed secondary radiation-induced cancer to be relatively low risk in this case. In contrast, cosmetic factors were more significant.