Articles and Case Studies

Honesty is always the best policy

26 Nov 2021

by Dr Jane Deacon

Honesty is always the best policy

Doctors have a responsibility to be open and honest in their communication with patients, even in the face of adverse events.

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

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

 


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

Library

Career complications and contending with uncertainty

Among the many challenges of the COVID-19 pandemic for junior doctors is how to respond to medical training impacts and career uncertainty. In this podcast, Dr Caroline Elton (a psychologist who specialises in helping doctors)and Dr Benjamin Veness (a Psychiatry registrar) share advice for coping with medical training and career delays, disruptions and unknowns.

Podcasts

10 Aug 2020