Even the most experienced clinician can face unexpected challenges. A single complaint or claim can be professionally draining, emotionally exhausting and disruptive to the care you want to provide.

At Medical Protection, we support members through criminal, disciplinary and regulatory investigations, complaints, ethical dilemmas and clinical negligence claims, and we see first-hand the toll these can take. 

We do not however only step in when something goes wrong. Just as clinicians aim to prevent symptoms before they escalate, at Medical Protection we believe a medical defence organisation should do the same. We work to help you avoid medicolegal problems long before they reach the stage of a complaint or claim.

One of the most effective ways to do that is by learning from real cases: understanding where things most often go wrong, recognising early warning signs and translating those insights into safer, more confident day‑to‑day practice. 

This article focuses specifically on clinical negligence claims experienced by consultant gynaecologists working in private practice in the UK, examining high-value claims managed by Medical Protection over a 12-year period. This specifically excludes any obstetric care.

Across the 12-year period the most common underlying causes for high value clinical negligence claims involving gynaecologists were: 

• Inadequate surgical technique 
• Failure to involve a specialist 
• Poor post-operative care 
• Inadequate consent process 
• Insufficient documentation 

By sharing these findings, we aim to give members practical, evidence‑based learning that can strengthen clinical practice, enhance patient safety and reduce exposure to claims. 

Surgical technique

The most common outcomes due to alleged poor surgical technique were bowel perforation (predominantly small bowel), nerve injury, arterial injury and bladder/ureter injury. Subsequent to these injuries, concerns were often raised that the injury was not identified during the operation and hence a significant delay in treatment occurred. In addition, the choice of operation or surgical approach (for example open versus laparoscopic) was also questioned in several claims particularly when more conservative options were potentially available.

Specialist involvement

In multiple cases, the gynaecologist was criticised for not involving a specialist during the assessment or treatment of the patient, but most commonly this involved a failure to involve a general surgeon when the patient presented with a complex surgical history pre-operatively or during the operation when complications occurred. Sadly, this could in some cases be due to a simple failure in communication as to when the pre-operative assessment or operation were taking place.

Post-operative care

Criticism of post-operative care mainly arose from failure to identify complications of surgery (commonly bleeding, bowel perforation and infection) in a timely fashion, often due to inadequate monitoring or failure to act on clinical signs (raised CRP, hypotension, abdominal pain) leading to a delay in treatment. Availability of the consultant or difficulty in contacting the consultant post-operatively also featured within several claims.

Consent

Clinicians are increasingly aware of the necessity to provide adequate detail of the risks and benefits of any procedure or treatment they provide. Whilst concerns still arise that the patient was not warned of specific risks or complications, it does appear that the expectation is now that the consent should be more tailored towards the individual patient rather than the general treatment offered. For example, advising the patient regarding increased risks of complication/infection due to regular intake of immunosuppressant medication. In addition, often the vulnerability identified in relation to consent was the failure to advise of alternative options/the option of no treatment/offer a second opinion. Finally, in investigative procedures it has become increasingly clear that detailed consent procedure should include not only the risks and benefits of the original investigative procedure, but also any subsequent treatment that may be undertaken during the operation, and for this to be clearly documented.

Documentation

Not unexpectedly, documentation was often a critical factor in the decision as to whether a claim should be settled or defended as clear documentation can demonstrate what actions or discussions have or have not taken place. In many cases there was often an alleged failure to document in sufficient detail the consent process (options offered, risks/benefits advised), reasons for choosing a particular procedure, the operation note or evidence of adequate post-operative review/assessment. Simple errors in documenting test results or passing on incorrect test results to colleagues, particularly within the IVF arena, also featured within these claims.

Steps to reduce risk

Medical Protection is aware that it can be incredibly distressing to discover that a patient is unhappy with their care, to the extent that they feel the need to bring a claim against you. Our experienced team is here to support members through every step of that process should that happen, however there are several steps gynaecologists can take to minimise their risk of a claim or adverse incident occurring:

• Be alert to the possibility of adjacent organ injury peri-operatively, particularly small bowel injury. 
• Consider and discuss with the patient all treatment options, particularly more conservative approaches when they are appropriate. 
• Have a low threshold for involving specialist colleagues, particularly in the pre-operative assessment of complex patients. Ensure you have a clear process in place for informing any specialists involved of when and where their input will be needed. 
• Document a clear post-operative plan of when and how you should be contacted if any complications arise, how often observations should be undertaken, and which other specialists should be involved if required. 
• Undertake a thorough consent process. Ensure the patient is aware of the risks, benefits and complications of the procedure, but also any alternative or subsequent treatment options. Consider if the consent process needs to be tailored to that individual, depending on any comorbidities, medications or social history. Ensure you are up to date on the latest GMC guidance on decision making and consent.
• Consider the use of supporting information such as patient information leaflets or digital resources to ensure full patient understanding. Use of these should also be documented in the records and regularly checked to ensure they are up to date and still fit for purpose.
• Ensure you have included sufficient detail in your records, particularly in relation to treatment options discussed, the consent process, operative note and post-operative plans and reviews.

Case example

Mr T, a consultant gynaecologist, saw Patient A in their private practice in relation to persistent menorrhagia and ovulation pain. Patient A had an extensive history of abdominal procedures due to Inflammatory Bowel Disease and had recently been diagnosed with an ovarian cyst.

Mr T discussed the different options available for treatment with Patient A, explaining the risks and benefits of each, with the patient deciding that a total abdominal hysterectomy and bilateral salpingo-oophrectomy was their preferred choice. Due to their abdominal surgical history Mr T arranged for Patient A to see Miss B, a general surgeon for pre-operative assessment. Miss B advised of the potential for multiple adhesions to be present and agreed she would be willing to assist if required.

Mr T scheduled the surgery for a Wednesday at the private hospital. He assumed that Miss B would be present as she usually had an operating list there on a Wednesday but did notinform Miss B of the date in advance to ensure availability.

During the operation Mr T found loops of small bowel firmly adhesive to the peritoneum and the uterus and had difficulty identifying the left ovary. At this stage Mr T called Miss B for assistance, but there was no reply, due to Miss B being on holiday. Mr T decided not to call another general surgeon and continued with the operation. During the operation the small bowel was perforated but not identified at the time. The perforation was diagnosed post-operatively by which time the patient required a temporary ileostomy and prolonged ITU stay.

A claim was brought against Mr T for proceeding with no general surgeon available, failure to call a general surgeon when adhesions were discovered and failure to work within the limits of their competence.

The claim was settled, and Mr T reflected that he would ensure attendance of a general surgeon at an earlier stage for similar circumstances in future. He also recognised the importance of clearly documenting the process to confirm the attendance of a general surgeon.