Learning from cases - General SurgeryArticle

Common themesDividing RulePatient complaints
We have analysed the complaints where we’ve supported general surgeons, including complaints arising from 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:Poor communication, manner, and attitude during a consultation, including rudeness, abruptness, racist remarks, lack of empathy, and disregard for concerns raised by patients. Complaints raised by colleagues also related to communication, such as junior doctors citing dismissiveness and refusal to accept referrals. Inappropriate or unnecessary intimate examinations, on occasion without a chaperone present.Unexpected outcomes following surgery. This was often triggered by dissatisfaction with the consent process, including inadequate discussion of risks and treatment options. This was particularly the case when the procedure was cosmetic in nature. Failure and delays to diagnose post-operative complications, including delays in identifying bleeding, peritonitis, and obstruction. Delay in the diagnosis of cancer, or providing reassurance that cancer was not present in the absence of appropriate investigations.
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 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 related to more than one concern or a series of clinical incidents. A number of cases arose from patient complaints where either the patient was dissatisfied with the complaint response received or concurrently raised concerns with the GMC.The common themes were:

Performance concerns, such as operative skills, including a higher than expected rate of complications, not being capable of operating independently, and clinical judgement such as choice of surgical procedure.

Poor communication, for example abrupt or dismissive manner during consultations.

Bullying and harassment of junior colleagues or other staff members. Refusal to attend hospital to assist junior colleagues when on call.

Probity issues, for example performing private practice in NHS time.

Inappropriate delegation or supervision.

Health issues, such as misuse of alcohol or drugs.

Failures or delays, for example in diagnosing malignancy, recognising and acting on postoperative clinical deterioration, or treating sepsis or bowel obstruction.

Issues arising from personal conduct, such as domestic violence, misuse of social media, and driving offences.

In the absence of representation by a defence organisation, the cost of instructing a solicitor to assist with a regulatory or disciplinary matter can be significant. For example, the costs incurred on one of the cases considered during this time period was in excess of £180,000.InquestsWe assisted members in writing statements and attending coroners’ inquests on over 200 occasions between 2016 and 2022. 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. Our analysis identified the following themes:

Delay in diagnosis of malignancy.

Delay in diagnosis of bowel obstruction.

Ruptured aortic aneurysm – in some cases, patients died prior to any operative intervention.

Complications of bowel surgery resulting in death, including anastomotic leaks, peritonitis, bowel perforation, ischaemia, necrosis, obstruction, and injury to major blood vessels.

Other complications of surgery, including pneumonia, sepsis, intracerebral haemorrhage, thrombosis, intra-operative death, wound dehiscence, and pancreatitis.

ReportsAssistance was provided in over 300 report case types, including serious untoward incident investigations held by NHS Trusts. A number of these cases later led to inquest following the death of the patient.Similar themes were identified to the inquest cases, but other areas analysed included:

Production of a report for the police, e.g. following attendance of the patient in the emergency department for alleged assault, including stabbing.

Delays in accessing investigations such as CT scans.

Requests for statements to comment on the practice of a colleague undergoing investigation.

Statements for clinical negligence claims brought against the trust.

Criminal matters
Where criminal allegations were advanced towards general surgeons, they predominantly related to inappropriate touching or sexual assault of patients. Although many of these were closed without proceeding to a criminal charge or to court, allegations of this nature often lead to disciplinary or regulatory action, as well as investigation by the police.Never eventsWe continue to see cases arising from wrong site surgery and retained swabs.CTA Best Practice
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