Learning from Dermatology Cases: Minimise the Risks

In dermatology, as with all specialties, a patient may be dissatisfied with the outcome of the care or treatment they have received. As a result, a complaint or clinical negligence claim may be initiated by the patient. Any such action invariably causes significant stress and anxiety for the clinician. We hope that sharing our experiences with dermatology cases will assist you in enhancing patient safety and reducing your risk profile.

Case Study

Mrs M consulted Dr A, a consultant dermatologist, regarding treatment for hirsutism. Various types of treatment were discussed and the patient agreed to commence a course of intense pulsed light technology (IPL). Dr A discussed the risks and benefits of the intervention, including special precautions before and after treatment. He completed a consent form, which stated the following:

• the success of the treatment was not guaranteed
• the results from the treatment vary considerably
• there may be short-term side effects such as reddening, mild burning or blistering, hypo-pigmentation or hyperpigmentation as well as rare side effects such as scarring.

Mrs M signed the consent form and was provided with a copy.

Following the completion of the course of treatment, Mrs M appeared satisfied with the results. Dr A kept concise and detailed notes in Mrs M’s medical records of all the consultations.

Six months later Dr A received a letter of complaint from Mrs M stating that she was dissatisfied with the results of the IPL and requested compensation. She alleged that the IPL laser system used was substandard and had caused facial burns.

Dr A was surprised by Mrs M’s allegations as she had not communicated any dissatisfaction with the results of the treatment during the consultations or experienced any complications or discomfort whilst undergoing treatment. Dr A recalled informing the patient that multiple sessions would be required and that each patient’s response to treatment varied. Dr A stated that he had followed the British Medical Laser Association treatment guidelines and ensured that the machine was regularly maintained and had a quality assurance programme in place. He thought that the result of the treatment was positive and that Mrs M had been pleased with the result at the final consultation.

Dr A contacted the PMP medicolegal helpline team, who then assisted him in preparing an appropriate response, which led to a successful resolution of the complaint.

Key Learning Points

Dr A had a consistent consent process explaining the risks, benefits, and alternatives of the proposed treatment. He had taken time to discuss the intervention with the patient and provided evidence of the process on a consent form and contemporaneous notes in the patient’s medical record. In essence, he had practiced in accordance with the GMC’s consent guidance.

Inadequate informed consent is frequently identified as a contributory factor in a patient’s dissatisfaction with the care provided, which ultimately has the potential to lead to litigation. Dr A’s detailed, contemporaneous records assisted him in responding effectively to the complaint from Mrs M. Good medical records are a vital component of providing high-quality patient care and are often viewed as a reflection of the standard of care provided.

In Summary

• Clear and comprehensive communication between doctor and patient is crucial, this includes during and after treatment.
• Take the time to educate patients about potential risks, this approach will help to reduce liability exposure. Discussing with the patient about realistic expectations and outcomes is particularly important.
• In some circumstances it may be better to decline treatment for a patient who has unrealistic expectations.
• Maintain clear and accurate medical records. All healthcare clinicians should keep their knowledge and understanding of the GMC’s professional guidance on good record keeping up-to-date.