Clinical Risk current issue

Clinical risk in aesthetic surgery

Mercer, M. N. — Fri, 13 Nov 2009 08:58:15 PST

Aesthetic surgery and regulatory risk for doctors

Slack, M. R. — Fri, 13 Nov 2009 08:58:15 PST

The regulatory framework, in which all doctors work, is governed by the General Medical Council (GMC) in the United Kingdom. This article highlights areas of risk by reference to GMC publications and rulings, which can lead to doctors working in aesthetic surgery, coming under their scrutiny, and how best to avoid that event.

Managing risk to reputation

Boyd, M. M. — Fri, 13 Nov 2009 08:58:15 PST

Doctors, particularly in aesthetic surgery, are increasingly under public and press scrutiny. This paper sets out how, and why, the press can influence the outcome of a professional investigation or the expression of anger by a disgruntled patient. Seven steps are set out which clinicians can follow to minimize the risk to their reputation.

France sets standards for practice of aesthetic surgery

Fogli, A. — Fri, 13 Nov 2009 08:58:15 PST

Dr Alain Fogli is a member of the ISAPS Specialty Promotion Committee and ISAPS National Secretary for France. Dr Fogli has been Chairman of the Board of Directors of the Syndicate of Plastic Surgery in France for over five years. The National Syndicate is a National Union whose purpose is to protect the specialty and the Syndicate has an official spokesperson for the Government. Members of the Board of Directors are elected by French plastic surgeons. The changes initiated in France were in response to extensive publicity about cosmetic surgery that drew attention to the lack of traditional safeguards for patients. It became necessary for the Government to learn more about the field of cosmetic surgery, including its financial and safety aspects. The Government initiated an inquiry and the Syndicate was subsequently invited to participate in the writing new regulations. Dr Fogli and Dr Hepner met with the Health Minister to assist in formulating the regulations and the final proposition was put to Parliament and passed into Law.

The regulations are also designed to monitor the practice of cosmetic surgery and to avoid possible abuse.

Clinical risk in cosmetic surgery

Bradbury, E. — Fri, 13 Nov 2009 08:58:15 PST

Psychological issues are central to cosmetic surgery procedures. Motivation is driven by the aim of achieving improved psychological and social wellbeing. A poor technical outcome will undermine those aims in the normal population, but for those vulnerable individuals with underlying psychopathology or personality disorders, the risk to their psychological state can be significant. Some patients will always be at psychological risk, whatever the technical outcome, and are less able to make an informed consent to treatment.

This paper describes the types of psychological risk associated with specific procedures, and the psychiatric conditions most commonly found in the cosmetic surgery population.

Clinical guidelines are given for both patient and practitioner. Prospective patients are give advice on how to reduce their exposure to psychological risk, and practitioners are given guidelines on the selection of patients for procedures, and ways of developing referral pathways to mental health services where appropriate.

Minimizing risk in aesthetic surgery

Nahai, F. — Fri, 13 Nov 2009 08:58:15 PST

Aesthetic or cosmetic surgery is now an international market. The USA has led the field in aesthetic surgery for decades but it has also led the way in the medicolegal market. The market in the USA is unregulated and patients are prepared to travel long distances to see the ‘the best’ or to get ‘value for money’. Various recommendations are made to reduce risk. Comparisons are made, and risks of surgical tourism highlighted.

Risk reduction in cosmetic surgery

Khoo, C. — Fri, 13 Nov 2009 08:58:15 PST

Cosmetic or aesthetic surgery is defined as ‘operations or other procedures that revise or change the appearance, colour, texture, structure or position of bodily features to achieve what patients perceive to be more desirable’. It differs from reconstructive surgery in that patients do not suffer from surgical pathology, but come to a surgeon desiring alteration of appearance to achieve an improvement. It has been said that cosmetic surgery patients differ from those presenting to other surgeons, in that instead of hoping that they do not need an operation, in cosmetic surgery the wish to undergo surgery is the patient's primary motivation for the consultation.

There are distinctive risks in cosmetic surgery. The focus is on an individual surgeon, rather than a system of institutional care delivery. The surgeon's assessment and selection of patients is crucial to the avoidance of subsequent dissatisfaction. Mainstream surgical training concentrates on the acquisition of knowledge and technical competencies: the cosmetic surgeon's armamentarium must include in addition superlative communication skills and a degree of psychological awareness which will allow exclusion of those patients for whom it is unlikely that satisfaction can be achieved. It may circumvent disaster for the surgeon to say ‘no’.

Awareness of inherent clinical risks and the ability to manage them are crucial to successful practice, as is the surgeon's commitment to support and encourage the patient throughout the entire process. There is, however, the potential for extremely high levels of satisfaction for both surgeon and patient if pitfalls are avoided, and risks are managed appropriately within a positive doctor–patient relationship.

Improving the safety of aesthetic surgery: Recommendations following a 14-year review of cases referred to the Medical Defence Union from across the United Kingdom (1990-2004)

Grover, R. — Fri, 13 Nov 2009 08:58:15 PST

Aesthetic surgery differs from all other forms of surgery in being a treatment for ‘want’ rather than ‘need’. Historically it has been a field with a significant rate of litigation as a result of the high expectation of patients. A 14-year audit of claims to the MDU between 1990 and 2004 has allowed a unique insight into the nature of events which patients deem significant and lead them to seek litigation. The top line findings of this review have allowed this article to suggest some recommendations to reduce risk in aesthetic surgery. Ninety percent of the claims had as a significant component a deficiency in documentation which made the case difficult to defend. This article looks at where these deficiencies in documentation lay to make recommendations for surgeons practising aesthetic surgery.

Editorial

Walsh, P. — Fri, 13 Nov 2009 08:58:15 PST

Tuberculosis: clinical management and medicolegal pitfalls

Branley, H. M — Fri, 13 Nov 2009 08:58:15 PST

This paper describes the diagnosis and treatment of the various forms of tuberculosis covering drug resistance and at-risk groups. The second part of the paper considers the medicolegal aspects of failure to diagnose and treat with appropriate therapy.

Erratum

Fri, 13 Nov 2009 08:58:15 PST

Access to Justice in lower value clinical negligence claims

Heyes, C., Pirozzolo, R. — Fri, 13 Nov 2009 08:58:15 PST

In May 2009 Lord Justice Jackson published his Preliminary Report into the costs of civil litigation. His objective focuses on promoting access to justice at proportionate cost. Unsurprisingly, Claimants' costs in personal injury and clinical negligence claims are under the spotlight, principally, it seems, because of concern that the recovery of success fees and After The Event (ATE) insurance premiums is rendering Claimants' costs disproportionate to the damages recovered. This article will:

Review the existing Conditional Fee Agreement (CFA) and ATE insurance funding landscape for clinical negligence claims worth less than £60,000;

Explore the potential impact on access to justice for Claimants if partial costs shifting is introduced;

Suggest some alternative ways of controlling costs.

Book review: Medical Ethics and the Elderly. 3rd edn

Hopkins, C. — Fri, 13 Nov 2009 08:58:15 PST

Cases: Failure to diagnose tuberculosis: DP v Dr Vasa Gnanapragsam

Spencer, J., Spencer, M., Davidson, R., Dodd, G., Hopkins, A. — Fri, 13 Nov 2009 08:58:15 PST

Cases: Negligent anticoagulation leading to compartment syndrome: O v U NHS Trust

Johnson, A., Powell, D., Hempsons, — Fri, 13 Nov 2009 08:58:15 PST

Cases: Severed patella tendon during knee replacement surgery: B v Nuffield Hospitals

Patton, S., Weir, R. — Fri, 13 Nov 2009 08:58:15 PST

Editorial

Mead, J. — Fri, 13 Nov 2009 08:58:15 PST

Radiologist not liable for failure to spot lacrimal gland abnormality: Tina Morris v University Hospitals Birmingham NHS Foundation Trust (Birmingham County Court, 27/1/09 - Judge Worster)

Hodgetts, T., Brittan, B. — Fri, 13 Nov 2009 08:58:15 PST

Orthopaedic surgeon's conservative approach justified: David Swain v Harrogate and District NHS Foundation Trust (Leeds County Court, 17/4/09 - Judge Langan QC)

Fri, 13 Nov 2009 08:58:15 PST

Orthopaedic surgery - treatment of accident victim not negligent: James Smith v Countess of Chester Hospital NHS Foundation Trust (High Court, 27/04/09 - Judge McKenna)

Fri, 13 Nov 2009 08:58:15 PST