- PRASIS Home
- News & Media
- News Articles
- Documenting complaints: your correspondence should always remain factual
Documenting complaints: your correspondence should always remain factual
25th February 2024
We all know how important it is to accurately and fully document conversations and consultations with patients, both pre- operatively and post-operatively. Your notes should include details of all relevant discussions held as part of the consultation, including your explanation of the risks, descriptions of the surgery and conversations about outcomes and expectations. You should continue to document discussions post-operatively, and, where appropriate, include details of any issues that have arisen.
When writing your clinic letters, it is important that you remain factual at all times. If a genuine error has occurred, you have a duty of candour to inform the patient. If a complaint has been made or the patient has expressed their dissatisfaction during a consultation, this must be detailed clearly.
In the absence of a genuine error however, it is important that any correspondence with the patient does not unnecessarily jeopardise your position. While you must be transparent and honest about surgical outcomes, this does not extend to assuming blame or liability for inherent or identified risks of surgery or for acceptable surgical outcomes which fall short of a patient’s expectations.
To provide a fictional example, a patient has a bilateral breast augmentation under the care of a consultant. The patient is consented thoroughly and the procedure goes ahead uneventfully. However, post-operatively the patient develops nipple necrosis and nearly loses the nipple. The consultant has done everything that they should have done in this scenario – the patient was high risk for wound breakdown due to her BMI and the fact she was a smoker. She was warned about this risk, and she was aware of the things she needed to do to help prevent it.
In a post-operative clinic letter written by the consultant, they state:
“I am sorry you have been faced with this issue. It was an unfortunate error and should not have occurred.”
The consultant, quite naturally, is intending to sympathise with the patient’s position as she has suffered distress. However, the statement implies that the consultant is to blame, which is not necessarily the case.
A more suitable way of wording this may be:
“I am sorry you have been faced with this issue. As we discussed in detail, nipple necrosis is an inherent risk of this sort of surgery, and a particular risk in your case due to your BMI and history of smoking. Whilst we can and did seek to limit the risk of its occurrence, we cannot eliminate the risk entirely.”
This scenario may be quite obvious to some, but there may be some more subtle situations, for example:
“The left breast hasn’t settled as intended. It is not always possible to predict exactly how breasts will sit due to the elasticity of the skin.”
|
may be better than:
|
“I think I should have placed the left breast higher.”
|
“Fat removal is always better to be done conservatively as the risk of removing too much fat is greater than not removing enough; we can review the result once you are fully healed.”
|
may be better than:
|
“I didn’t remove enough fat from your abdomen.”
|
The letters that you write to your patients will remain on file for a long time and may become relevant to a claim months or years after the event. If you have a patient who happens to pursue a complaint or claim against you, it is important that your notes, and correspondence with the patient, provide a clear, honest review of the facts.
The nature of your work leaves you wanting to help people as much as you can, and as a profession you can often be overly critical of your own work. In addition, many patients have high expectations of the results of surgery, and can have an underappreciation of its inherent or identified risks. It is important that you do not blame yourself for situations that are quite likely to be normal consequences of surgery, and which have been identified to the patient as part of the consultation process.
If you are unsure, please contact the medico-legal helpline before documenting any issues that may become apparent post-surgery. The examples above are simply providing guidance on normal consequences of surgery. There will, of course, be situations where genuine errors have occurred, and these will need to be documented in the notes and the patient will need to be informed in writing, as part of your professional duties.
Emily Borhan
PRASIS Medico-legal Adviser