Practice of colorectal surgery opens numerous vulnerabilities
- • Failure to timely diagnose disease: eg, colorectal
cancer is the second most common type of cancer cited in malpractice
- • 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
Specific challenges to physicians cited in malpractice cases
- • 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,
- 2. To follow recommended medical
- 3. To adhere to excellent documentation
in the chart, informed consenting process, and documentation of
refusal to undergo recommended test/procedure.
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.
- • Inadequate evaluation of abnormal findings.
- • Failure to convey to patient the importance of
keeping test and follow-up appointments.
- • Multiple providers for the same patient fail
to properly communicate important information.
- • Patient not notified of test results.
- • Informed refusal not documented.
- • Important clinical information missing from clinical
- • 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),
- • 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 ...