Risk Management

When Complications Arise, Honesty Is the Best Policy

By Jerome W. Bettman Sr., MD

Argus, May, 1992

When, despite your best efforts, a complication of surgery occurs, it is in your best interest-as well as the patient’s-to tell the patient what has happened as soon as possible. Be honest. Never try to obscure the fact that a complication has occurred. Tell the patient that you will do everything in your power to help. Reassure the patient that you will ensure that he or she receives the best possible care and will not be abandoned.

If, during the informed consent process the patient was told that the results could not be guaranteed, it will be easier to explain that this case most likely fell into that group of complications that were discussed preoperatively. It does little good to blame yourself or the patient for the complication. Even if the patient might have been at fault, this generally will not be accepted as a justification.

The most difficult medicolegal cases to defend are those in which the surgeon was not forthright with the patient or did not seem sympathetic or concerned. It is amazing what difficult situations patients will accept gracefully if they have been treated with kindness and sympathy, and if they have been properly informed at every stage of the procedure, from the first visit through the postoperative period. Otherwise, the surprised, angry patient will be more likely to seek an attorney.

A case in point involves a 23-year-old auto mechanic who sustained a foreign body injury to one eye while hammering out a fender. The surgeon warned the patient that the foreign body had caused significant and irreparable damage upon entering the eye and that there would be further trauma to the eye during removal of the fragment. Unfortunately, the metal did not respond to a magnet and had to be removed with forceps, which caused a vitreal hemorrhage. Glaucoma ensued, and the patient eventually lost the eye.

The ophthalmologist averted a potential lawsuit by reminding the patient that they had previously discussed the possibility of serious complications. In explaining that everything possible had been done to save the eye, the ophthalmologist expressed sympathy and concern regarding the poor outcome. He assured the patient that he would continue to carefully supervise care of the remaining eye.

In some cases, you may want to suggest bringing in a consultant ophthalmologist. Do so early in the case. Tell the patient that because you are familiar with the skills, training and experience of the various ophthalmologists, you know who can be the most helpful. A complicated situation can be further complicated by a poor consultant.

Always adhere to these risk management principles:

  1. Be certain to convey the proper information to the patient in a clear and understandable manner so he or she can give meaningful consent to surgery. This is essential.
  2. Discuss the complication and its effects honestly. Never obfuscate.
  3. Be sympathetic and kind.
  4. Reassure the patient that you will continue to provide the best care possible.
  5. Suggest a consultant ophthalmologist if the patient wishes to see one.
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