Minor operation – major problem
Being relatively experienced at his level, he was concerned with the appropriateness of the prescribed treatment, but felt uncomfortable contradicting his senior
Mrs W, a 25-year-old secretary, was referred by her GP to a local general surgeon, Mr D, with troublesome warts on the middle finger of her dominant hand. On the day of the consultation, there were pressures in the consultant’s outpatient clinic as one of his juniors had unexpectedly gone off sick. In the event, he did not make any record of the consultation, but completed a booking form for Mrs W to have “diathermy of warts” on the minor surgery list delegated to junior doctor Dr Q.
On the day of the procedure, Dr Q was unsupervised for this list. He searched the notes for some advice or indications by way of an entry or letter to the GP, but could find none. Being relatively experienced at his level, he was concerned with the appropriateness of the prescribed treatment, but felt uncomfortable contradicting his senior so, after asking the patient to sign the form of consent, proceeded nevertheless.
Some days later, the patient returned with a black sloughy wound over a 1.5cm area on the dorsum of the PIP joint, which went on to become infected despite the prescription of antibiotics. Another member of the team subsequently saw Mrs W and realised that the developing wound was exposing the extensor tendons and asked an orthopaedic colleague if she would perform a skin graft to get the wound healed. This was done under local anaesthetic, using skin harvested from the patient’s chest wall. Unfortunately, the graft didn’t “take” well and the finger wound proceeded to heal slowly by scar formation.
There is no such thing as a “minor operation”
Mrs W went on to need several months’ physiotherapy to her hand, but was left with very significant stiffness in the finger. She also unfortunately developed a nasty scar on her chest at the site of skin graft harvest. After returning to her job she found herself only able to type at much reduced levels of efficiency and lost her job in a subsequent staff review at her firm. She became very depressed. Mrs W made a claim against both Mr D and Dr Q. Expert opinion was sought during the process and it was agreed that there was neither adequate informed consent nor appropriate primary treatment for the condition. The claim was settled for a moderate sum.