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Practice of colorectal surgery opens numerous vulnerabilities for lawsuits:

  • • Failure to timely diagnose disease: eg, colorectal cancer is the second most common type of cancer cited in malpractice lawsuits.
  • • Sphincter injury with fecal incontinence after anorectal surgery or midline episiotomy.
  • • Failure to offer continence-preserving procedure.
  • • Iatrogenic medical complications/death during diagnosis or treatment.
  • • Sponges/instruments left in the patient.
  • • Iatrogenic organ injury of nontarget structures (eg, colon, small bowel, ureter, major vessels, spleen, vagina).
  • • Lack of informed consent regarding extent or risks of procedures/endoscopies.

Specific challenges to physicians cited in malpractice cases arise from:

  • • Type or sequence of diagnostic procedures, eg, failure to recommend colonoscopy.
  • • Missing or insufficient documentation for medical rationale to recommended treatment, patient education, follow-up.
  • • Lack of follow-up on test results, initiation of follow-up tests (eg, after incomplete colonoscopy).
  • • Lack of communication.

Risk of lawsuit can never be completely eliminated but can be dramatically reduced, if the outlook of success for the plaintiff is lower, due to the fact that systematic preventive steps are undertaken:

  • 1. To reduce misconceptions, miscommunications.
  • 2. To follow recommended medical guidelines.
  • 3. To adhere to excellent documentation in the chart, informed consenting process, and documentation of refusal to undergo recommended test/procedure.

Key Elements

Delays to Prompt Diagnostic Evaluation in Patients with Symptoms

  • • Routine screening not recommended.
  • • Routine screening recommended but not scheduled.
  • • Diagnostic test recommended but not scheduled.
  • • Diagnostic test scheduled but not performed.
  • • Ordering or follow-up of screening or diagnostic procedures not documented.

Narrow Diagnostic Focus

  • • Inadequate evaluation of abnormal findings.
  • • Failure to convey to patient the importance of keeping test and follow-up appointments.

Lack of Communication

  • • Multiple providers for the same patient fail to properly communicate important information.
  • • Patient not notified of test results.

Poor Documentation

  • • Informed refusal not documented.
  • • Important clinical information missing from clinical note.


Baseline Documentation

  • • Adequate documentation of current history elements; clarification of patient’s vague terminology (eg, “occasional,” “frequent”) → reduce misinterpretation of self-reported symptoms.
  • • Key statements must be documented by selected outside medical records, eg, pathology report (cancer, IBD), colonoscopy report (clearance of rest of the colon), operative notes (definition of anatomy, problems/adhesions during previous surgeries), medical clearance.
  • • Amendments to existing chart/medical record: if an addendum is absolutely necessary, it should be made after the last entry, noting current date and time, with both entries cross-referenced. Inappropriately amended medical records render a case indefensible if plaintiff’s attorneys demonstrate in court that the note was written or typed ...

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