Abstract

Medico-legal consequences in surgery due to inadequate training in anatomy

Author(s): Professor Harold Ellis C.B.E, F.R.C.S.

You do not need to be a member of the medical profession to be aware of the frightening increase in medico-legal claims against surgeons in the U.K. Indeed, it seems that every day some newspaper has a report of some new and sensational 'surgical disaster'. The hard facts speak for themselves. A report from the National Audit Office showed that the bill for medical negligence faced by the NHS in 2000 amounted to £2.6 billion, double the amount paid out in 19971 , and this figure is now well above £3 billion. This report also pointed out that the rate of new claims per thousand consultant episodes rose by an incredible sevenfold between 1995-6 and 1999-2000. Part of this phenomenon is the increasing expectations of patients and their families. Anything short of a perfect result may be queried. A minor superficial wound infection following life-saving emergency surgery for faecal peritonitis in an elderly, immuno-compromised patient may be followed by a visit to the solicitor. However, a report from the Medical Defence Union (MDU) of claims made against it2 showed that the most common reason for compensation pay-outs in General and Vascular Surgery, amounting to 32% of the claims, was for 'damage to underlying structures' - a figure similar to that noted in an eight year review published in 1998. What is 'damage to underlying structures' in a surgical operation? - in the majority of cases this means some anatomical error or even disaster. Let me give some examples from three types of surgical procedures: