Urologists and Risk Management - Good Practices to keep the Lawyer Away, 24 Nov 2018

Urologists and Risk Management – Good Practices to Keep The Lawyer Away

Dr Clarence Lei Chang Moh, FRCS Urol, FEBU,

Consultant Urologist,

Adjunct Professor,Universiti Malaysia Sarawak, 

 Honorary Consultant Urologist to HKL, SGH, SHC,

 c/o Kidney & Urology Centre, Normah Hospital, Kuching.

Introduction:

There is an increasing trend of patients making official allegations against doctors, sometimes with the “help” of lawyers. Medical management of certain conditions or in some situations incurs more risk than others to result in unpleasant encounters. Medical “malpractice” insurance is now mandatory in Malaysia, adding a significant cost!

Methods:

The author qualified as a medical doctor in 1981 and the “practices in relation to risk management” are mostly from his personal experience in the local scene.  The sources of information includes: personal medico-legal cases, medico-legal cases as expert witness in and outside court, discussions and advices for cases involving fellow urologist (anonymized), medico-legal cases from the MPS, Malaysian Protection Society case book since 2002, MPS workshops and the MMA report of the Ethics Committee since 2006.  

Results:

When a clinical case scenario takes on a medico-legal angle, the time and effort spent of studying the case, reading the documents are often overwhelming.  The subject matter includes the following: informed consent, urinary stone management in relation to stone migration, stone clearance, ureteric avulsion, bleeding and lethal urosepsis; post varicocele surgery, in particular, alleged testicular atrophy, scrotal swelling and pain, missed testicular torsion, failed vasectomy, post TURP retrograde ejaculation, spinal cord compression resulting in urinary retention and sexual dysfunction, post nephrectomy bleeding and death, adverse drug reactions, fraudulent claims and advertisement etc. Less than ideal urological repair of urological injuries caused by gynaecologists is another source of unhappiness.

Conclusion:

The outcome of some of these cases will be discussed. In general, it is best to be humble (allow second opinion!), honest and allow open communication, including use of modern media.  Documentation of informed consent especially with regards to treatment efficacy and adverse events must be clear. The patient and family should have adequate time to decide on the treatment options, preferably not same day surgery.

Last but not least, the doctor should have adequate knowledge and training in the treatment options, safety aspects and have a supportive team.