EAU18 – Well-informed patients mean fewer legal woes

Patients well informed by their doctors on the risks of complex surgical and medical treatments are less inclined to fight bitter legal battles with healthcare professionals, said a renowned litigation lawyer during yesterday’s Plenary Session 2 tackling problematic surgical cases in bladder cancer.

In a full-house “Nightmare Session” chaired by urologist Tim O’Brien (GB), expert medical litigation lawyer Bertie Leigh (GB) returned for a second time to drive home his point on weak patient-doctor communication, which he says is often the reason why complex medical cases end up in the courtroom.

“The underlying point… is patient education. Doctors often hide behind the perceived protection provided by a consented patient but often miss the more important point of informing the patient,” said Leigh, who has conducted prominent cases in clinical negligence and regulatory law over the past 30 years.

The session reviewed three cases: the first concerning a patient who had radical cystectomy despite a post-operative pT0 finding (no tumour); the second an elderly patient who suffered intra and post-operative complications; and the third involving severe complications following a first transurethral resection of bladder tumour (TURBT).

Facing intense questioning by Leigh were Maximilian Burger (DE), Morgan Rouprêt (FR), Alexandra Masson-Lecomte (FR) and Hugh Mostafid (GB), who defended their surgical approaches.

In the first case, where the patient filed a suit (after cystectomy) due to the absence of a tumour, Burger said bladder removal was still warranted since there is a high rate of recurrence. He characterized it as a potentially “vicious” case, saying: “If you don’t do it right, it can lead to aggressive disease. No tumour doesn’t necessarily mean cure.”

However, Leigh said the issue was not so much about the strategy taken by the doctor, but the way the planned treatment was communicated to the patient.

“It would help if doctors were not always so nice to their patients. At some point you have to share your uncertainty with them and make them understand the risks or severity of the treatment,” said Leigh.

The second case examined issues such as the lack of consensus on intra-operative complications, patient education, and the role of recording complication rates.

“Surgeons are proud of their work and they don’t want to share the practical problems they encounter in practice. This session acknowledges that these clinical problems exist and we shouldn’t be ashamed of that, but instead take measures to work for quality standards or the improvement of current practices,” said Rouprêt. He added that doctors should not hesitate to consult a lawyer and exchange ideas with them to get practical advice.

“Guidelines cannot tell you how to deal with the practical issues you encounter in the operating room. They can provide the basic framework but in specific cases you are on your own, especially during very complicated situations,” he said.

Article by Joel Vega