Learning from cases - Orthopaedic SurgeryArticle

Common themesDividing RulePatient complaints
We have analysed the complaints where we’ve supported orthopaedic surgeons, including complaints arising from both the NHS and private practice. These were quite varied and sometimes related to multiple concerns. Most of the complaints were from patients, but some were from other healthcare professionals.The common themes were:Dismissive attitude or rudeness during consultations.Failure to manage post-operative complications.Failure to obtain informed consent for surgery.Misdiagnosis or delay in diagnosis.Delay in organising further care, such as physiotherapy.
Regulatory (GMC) and disciplinary investigationsWe are aware of the immense pressure and stress that many doctors go through during these investigations. We always aim to provide members with tailored care and expert support.GMC and hospital disciplinary cases have followed referral from patients, relatives, or colleagues, both senior and junior. There was a mix of clinical and non-clinical concerns. Some investigations relate to more than one concern or a series of serious clinical incidents. The common themes were:

Allegations of poor surgical competence, including higher than expected complication rates, poor functional outcomes, or lack of experience and technical ability for the operations being performed. In some cases, surgeons were restricted from operating while investigations were taking place.

Failure to obtain informed consent for procedures.

Manner and attitude towards colleagues and patients, including rudeness and derogatory comments.

Bullying and harassment, including inappropriate behaviour of a sexual nature.

Poor postoperative management of complications, including management of wound and prosthetic joint infections.

Allegations of theft of equipment from the hospital.

Failure to attend when requested while on-call.

Performing private work during NHS time or using NHS resources to do so, including secretarial resources.

Health matters, such as alcohol and drug misuse.

Probity issues, including fraudulent use of codes when billing in private practice or authorship of publications.

Criminal convictions arising from the surgeon’s personal life.

Failure to adequately assess claimants when writing medicolegal reports.

InquestsWe assisted members in writing statements and attending coroners’ inquests. An inquest is a fact-finding exercise that is conducted by the coroner and, in some cases, in front of a jury. The purpose of an inquest is to find out who died, when, where, how, and in what circumstances. Our Inquest Factsheet contains further information about what happens at an inquest.
We identified the following issues leading to members being asked to provide a statement or give evidence at an inquest:

Postoperative deaths due to pulmonary embolism. In some cases, postoperative prophylactic anticoagulation had not been provided or had been stopped due to bleeding from the surgical incision.

Other postoperative complications, including pneumonia, sepsis, myocardial infarction, bowel ischaemia or obstruction, and subdural haemorrhage (potentially resulting from anticoagulation).

Death due to prosthetic joint infection.

Death resulting from trauma.

CTA Best Practice
Learning from cases - Orthopaedic SurgeryArticle - IntroductionArticle - AnalysisArticle - Claims: procedures and contributory factorsArticle - Case StudyArticle - Common themesArticle - Orthopaedic surgery in the UK: top tips to minimise riskEnd Page