Articles and Case Studies

Surgeons and holidays - what are the risks?

20 Nov 2019

Nerissa Ferrie

by Ms Nerissa Ferrie

Aeroplane model

All medical practitioners should take time out to enjoy a break with the family or embark on a travel adventure, but some specialties require more advance planning than others. 

Experience tells us that claims and complaints are more likely to arise when a treating surgeon begins a period of leave during a patient’s post-operative recovery. This has been a topic of discussion around the tables of both our Western and Eastern Cases Committees, so we take a closer look at how to mitigate the risks for you and your patients.

What are the risks?

We spoke with some of our well-respected surgical members to seek feedback on this challenging issue, and all agreed that the profession is generally unaware of the increased risk of a surgeon taking leave in the post-operative period.

We have identified the common risks associated with a poorly managed period of leave, including:

  • inadequate cover
  • the covering surgeon not being familiar with the patient or any peri-operative issues
  • a rushed or inadequate handover
  • a reluctance to take the patient back to theatre – or a premature decision to do so
  • ED doctors being left to deal with post-operative complications
  • the covering surgeon not being aware of the treating surgeon’s usual preferences.
  • family members trying (unsuccessfully) to contact the treating surgeon because they don’t know the surgeon is on leave.

Top tips to reduce your risk

To make the most of the collective wisdom of our surgical members, we have compiled some practical tips to reduce your risk of a claim or complaint.

  • Notify your patients of your planned absence and arrange cover ahead of time.
  • Give your patient the option to postpone the surgery until your return.

  • I advise the patient I will be away and will be covered, but I give them the choice to postpone the procedure. I don’t book big cases before I go on leave unless I am well covered by a colleague who will see the patient as a routine to assess progress and reassure the patient.
    Gerard Hardisty, Orthopaedic surgeon

  • Prior to an emergency procedure, ensure the patient is aware (where possible) that you will be performing the surgery, but another doctor will be caring for them in the post-operative period.
  • Avoid major elective cases immediately before leave unless a trusted colleague has had adequate handover and is prepared to provide the same level of post-operative care you would provide yourself.

  • In my own practice I do not schedule patients for surgery in the week prior to taking leave. If urgent or semi-urgent surgery is required during this week, then I will arrange for it to be performed by one of my practice associates. This will allow the patients to have continuity of care.
    Frank J Martin, Ophthalmologist

  • Ensure your handover includes details about the patient’s condition, any peri-operative issues, and your best contact details if you prefer to be informed of any serious post-operative complications.

  • I believe in notifying patients of your planned absence, avoiding major cases in the five days pre-departure, and informing your colleague who is willing to cover of your patient’s condition, any relevant operative details and, these days, email or mobile contacts.
    Stephen Quain, Orthopaedic surgeon

  • Have a general backup plan in place in case your leave is unexpected (e.g. an urgent health problem) and cover cannot be arranged in advance.

Good communication is paramount

There are several points of contact where good communication can result in a better experience for the patient, including:

  • the pre-operative discussion between the surgeon and the patient, including advance notice of any planned leave and management of patient expectation
  • GP input if the patient is offered a postponement of the procedure
  • ensuring the hospital and the patient’s next of kin know who to contact in the case of a post-operative complication
  • handover between the treating surgeon and the covering surgeon
  • follow up if any issues arise during your absence.

The patient and their family generally have good rapport and communication with the surgeon. This communication may break down if this same level of communication has not been achieved with the relieving surgeon.
Frank J Martin, Ophthalmologist

Where to from here?

Patients do not like a surgeon operating and leaving them in someone else’s care. The fact that it is done so often, and nothing goes wrong, is testament to the competence of our surgeons.
Max Baumwol, General Surgeon

Surgeons operate across a wide range of specialties, and some procedures carry a greater risk of post-operative complications. There is no “one size fits all” approach to managing periods of leave, but it should be front of mind because patients place an enormous amount of trust in their treating surgeon.

Leave is important, but you can decrease your medico-legal risk if you manage it well. Before your next break, take time to consider the tips provided by your surgical colleagues, and plan ahead so you can enjoy a stress-free holiday.


Nerissa Ferrie
Medico-legal Adviser, MDA National



Communication with Colleagues, Communication with Patients, Complaints and Adverse Events, Practice Management, Anaesthesia, Dermatology, Emergency Medicine, General Practice, Intensive Care Medicine, Obstetrics and Gynaecology, Ophthalmology, Pathology, Practice Manager Or Owner, Psychiatry, Radiology, Sports Medicine, Surgery, Physician, Geriatric Medicine, Cardiology, Plastic And Reconstructive Surgery, Radiation Oncology, Paediatrics, Independent Medical Assessor - IME
 

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