That combination of desperation and knowledge is something that puts you on high alert as a consultant surgeon. I could see he’d done his research, and his conclusion was perfectly understandable given that he had explored several treatment options. But as well as being a potentially life-changing solution, a sympathectomy is a permanent one. If it didn’t go well, there would be no way back from it. 

I explained  the risks and benefits in detail, emphasising in particular the well-known side effect of compensatory sweating. He remained determined to go ahead – he felt the sweating was an acceptable risk that was outweighed by the benefits of the operation. So I agreed to perform the surgery and gave him a patient information leaflet to take home, asking him to call me if he had any further questions. 

A month later, I performed endoscopic transthoracic sympathectomies on both sides at T2. Everything went smoothly and he was discharged home on the same day.

Two years later, I received the letter we all dread. It was from my patient’s solicitors, asking for a copy of his medical records. 

In the intervening time, the patient had unfortunately suffered profoundly. The operation had resulted in compensatory sweating on his trunk and thighs. Far from resolving itself, this got worse and worse, to the point where he was having to change his clothes several times a day. He had become severely depressed and withdrawn, and deeply regretted having the operation. 

When I read the letter my heart started racing. Had I done everything possible to be sure of informed consent? Would there be a claim against me? Where might that lead? 

To stop the awful scenarios playing out in my head, I got straight on the phone to Medical Protection. They were great, so professional, reassuring, and sympathetic. The medicolegal consultant who was assigned to me asked me to send her copies of the medical records at the same time as sending them to the patient’s solicitors.

She got back to me very quickly. To my huge relief she said she felt I’d been very thorough in obtaining consent. I’d recorded in detail the preoperative consultation in the records, and had also sent a letter to the patient, copying in his GP, reiterating the risks and benefits of the operation. In her expert opinion, I was in a strong position to defend an allegation of negligence on the basis of failure to secure adequate consent. My Medical Protection team managed the legal communication and sent the patient’s solicitors a letter advising them about the evidence of consent . The patient’s solicitors agreed that I was in a strong position, and no further action was taken.

This situation only heightened my awareness of the risks around consent. The ‘well-informed patient’ is now a common phenomenon thanks to the internet. But there is a vast amount of information out there, and not all of it is sound by any means. Also, patients who have become attached to specific surgical procedures often have unreasonably high expectations about outcomes. This makes it more vital than ever that we give patients all the trusted information at our disposal, so that they can make properly informed choices about their treatment. 

This situation has really brought home to me the value of my Medical Protection membership. As well as being there for me when I needed them on a potential legal matter, the Medical Protection team are always there in many other ways too. I was glad to be reminded, for instance, that they run CPD courses on the ethical and legal challenges we face daily as consultants, including critical issues such as consent. Everything they do is characterised by an intimate understanding of the work we do – not surprising considering that there are so many doctors in the organisation. I always knew that I needed protection for my career and reputation, but now I fully appreciate the breadth and depth of it. 

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This case is based on a real scenario, with some facts altered to preserve confidentiality.