Thirty-year-old Mr P had suffered from facial and palmar hyperhidrosis and blushing since he was fourteen. Over the years, he had tried various over-the-counter remedies and a period of psychotherapy with no success. Although he had learned to live with his condition to some extent, he found it socially inhibiting and believed that it was preventing him from progressing in his career as an accountant.

Having researched hyperhidrosis on the internet, Mr P was attracted to the potentially permanent solution offered by a sympathectomy and asked his GP to refer him to a suitably trained surgeon.

Three weeks later he saw Mr R, a consultant surgeon, at his clinic and requested an endoscopic transthoracic sympathectomy, telling Mr R that he had conducted detailed research on the internet and therefore had a good understanding of what the surgery entailed. Although Mr P had clearly done his research and had already concluded that surgery was his best option, Mr R nevertheless explained the operation and its risks and benefits to him in detail, emphasising the well-known side effect of compensatory sweating.

After discussing the implications, Mr P was still intent on undergoing the surgery, indicating that he considered compensatory sweating an acceptable risk outweighed by the benefits of the operation. Mr R therefore agreed to perform the surgery, but gave Mr P a patient information leaflet to take home with him, asking him to read it and telephone him if he had any further questions.

Mr P was admitted as a day patient a month later for the surgery. Mr R performed endoscopic transthoracic sympathectomies on both sides at T2. The operation was uneventful and Mr P was discharged home later the same day.

The operation had the desired effect of eliminating Mr P’s problems with blushing and his facial and palmar hyperhidrosis, but it did result in compensatory sweating on his trunk and thighs. Unfortunately, this failed to resolve itself and increased in severity over the next 18 months, to the point where Mr P had to change his clothes several times a day. This was extremely distressing to Mr P. He deeply regretted having the operation and became profoundly depressed, unable to work and socially withdrawn.

Two years later, Mr R received a letter from Mr P’s solicitors requesting a copy of Mr P’s medical records. He alerted Medical Protection to the possibility that a claim would be made against him and sent copies of the records to the solicitors and Medical Protection. Fortunately, Mr R had documented the substance of Mr P’s preoperative consultation in the medical records and, furthermore, had followed up the consultation with a letter to Mr P (with a copy to his GP), in which he reiterated the risks and benefits of the operation.

In our opinion, Mr R was in a strong position to defend an allegation of negligence on the basis of failure to secure adequate consent for the operation. Mr P’s solicitors evidently agreed with our assessment as no further action was taken.

Learning points

• The “well-informed patient” is a common phenomenon in countries with widespread access to the internet. Although these patients may claim that they’ve thoroughly researched their treatment options and thought it all through, their doctors should still ensure that patients are given all the necessary information to make a properly informed choice.
• Doctors might also consider familiarising themselves with sources that are available.
• Patients requesting specific surgical procedures often have unreasonably high expectations about outcomes. They may be so focused on the perceived benefits of the surgery that they don’t give due regard to the risks.

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