Just a few hours later, my patient was rushed to the emergency department, complaining of severe lower abdominal pain coupled with nausea and chills.

Her abdomen was tender and slightly distended, her white cell count raised, and while x-rays were reported as being normal, a CT scan of her abdomen revealed free air in the upper abdomen overlying the liver. Free fluid was identified around the right lobe of the liver and hepatic flexure, and the hepatic flexure was noted to be oedematous.

Despite finding no definite site of perforation, the team considered the likely diagnosis was colonic perforation, and an emergency laparotomy was undertaken.  A perforation to the right colon was identified and repaired. After making a reasonable recovery, the patient was discharged home a few days later.

A few weeks later, I received a letter from the patient’s solicitor. She was bringing a case of clinical negligence against me, alleging that it was a breach of duty to perform a hot biopsy technique, and that the use of diathermy caused the bowel perforation.

The letter didn’t come as a complete surprise, but seeing it in black and white was shocking. I felt terrible that this vulnerable elderly woman had been through the ordeal that she had.

At the same time, I could see everything I’d worked for slipping away from me. The thoughts were like dominoes – if I lost my reputation, as a private consultant I could lose my livelihood. With awful clarity I saw the other losses piling up: the loss of my self-respect, the trust of my colleagues and family.

The one ray of light came in the shape of the medicolegal consultant assigned to me by Medical Protection. She was incredibly knowledgeable – it was a huge relief to talk to an experienced doctor who immediately grasped the clinical aspects of my case. She also absolutely got the emotional aspects. She was empathetic and proactive, quickly formulating a plan with me for how to move forward. This was so important to me – the thought of being in limbo, without any structured action, was unbearable.

My Medical Protection team instructed a consultant gastroenterologist to give an expert opinion. He felt that the consent I’d taken from the patient was limited, as a detailed discussion of the risks and benefits of colonoscopy, biopsy and polypectomy had not been clearly documented, and the information in the leaflet was insufficient. There was no evidence to suggest that we had discussed alternatives to diagnostic colonoscopy, such as CT colonography, or alternatives to polyp removal, including the possibility of doing nothing.

He also felt it had been inappropriate to use a hot biopsy technique in this case, referencing British Society of Gastroenterology guidance that states there is a risk of transmural thermal injury if hot biopsy is performed in the right colon where the colonic wall is thin. Bearing in mind the size of the polyp, it’s likely that a considerable amount of diathermy would be needed, and he felt it would have been preferable to remove it via endoscopic mucosal resection.

On the balance of probabilities, he concluded that the use of diathermy resulted in perforation of the bowel.

Taking into account the apparent vulnerabilities in the case, Medical Protection settled the matter on my behalf and with my consent, with a payment of over £125,000.

The expert’s report was a hard and humbling read. How could my standards have slipped like this? Yes, we are all incredibly busy, but my record keeping should have been better. I’d always prided myself on being thorough as well as compassionate. All I could see here was a lack of professionalism and a seeming lack of care for my patient.

With the support of my medicolegal consultant, I reflected deeply on the implications for my practice. I updated myself on the clinical elements, and read everything there was to read on consent, including Medical Protection’s own guide. I also took two of the immensely helpful essential skills courses included in membership, on consent and record-keeping.

The counselling included in my membership was an absolute lifeline. I was questioning everything, right down to my fitness to be a doctor. There’s no way I could have come back from this rock bottom without professional help. I came to see more clearly than ever before that thoroughness and compassion are inextricably linked – empathy is empty talk if it’s not coupled with practical action rooted in professional rigour. Every patient should be given information in a way that they can understand, in order to give truly informed consent, which especially for elderly patients requires an investment in time and thoughtfulness.

I also came to appreciate my Medical Protection membership in a way that I never had before. My medicolegal consultant and claims team, the instructed expert, the professionals leading the courses, my counsellor – all these people guided me through an indescribably challenging time. Without them I honestly don’t know how I would have coped.

Of course, my indemnity was a professional and financial lifesaver. The thought that I would have had to find more than £125,000 to cover the claim costs still makes my blood run cold. And without Medical Protection’s legal representation, the costs could have been even higher.

But Medical Protection goes so much further than protecting your career and finances. Every single person involved in your case is wholeheartedly committed to doing their best for you, as a human being as well as a medical professional. I could not have wished for a more supportive and proactive team. A team who ultimately enabled me to become better at what I do, for the benefit of all my patients.

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This case is based on a real scenario, with some facts altered to preserve confidentiality. Licensed stock imagery has been used for illustrative purposes only and to protect member confidentiality.