Howard Marsh

Unusual and not so unusual ways of ending up in court: how to avoid litigation.

For the patient, avoiding a situation that leads to litigation is clearly beneficial, for the patient will, usually, have suffered some harm (perceived or real) before initiating a legal case. The surgeon will benefit also, for defending any allegation of negligence is both time-consuming and stressful, even if the court eventually exonerates the surgeon. Thus, we regard the idea of ‘winners’ and ‘losers’ in clinical negligence litigation as inappropriate, and it is obvious to us that preventing a litigious situation is better than cure, for all concerned.

The development of consent from Bolam to Chester: what you need to know and what your patients are entitled to know.

The process of obtaining consent for treatment of the competent adult is governed by common law, i.e. by case law, rather than by statute. It is not our intention in this paper to consider the process of consent for the removal and storage of organs to be used for organ donation, the legal framework for which is governed by statute as laid down in The Human Tissue Act 2004, and which states: ‘To give consent, patients must understand (our emphasis) the nature and purpose of what is proposed. Thus, the person from whom the organ is removed must not only be informed of the nature and risks of the procedure, but must also understand that information’ (how understanding is tested is not specified). Nor do we discuss the process of ‘consent’ for the incapacitated adult, which is governed by the Mental Capacity Act 2005 (http://www.hta.gov.uk/_db/_documents/ 2006-07-04_Approved_by_Parliament__Code_of_Practice_1_-_Consent.pdf).

Renal cell carcinoma with retro-aortic renal vein thrombus: a case series.

Study Type – Therapy (case series)
Level of Evidence 4

Clinical guidelines: a sword or a shield in clinical negligence litigation?

It is not our intention to discuss the very wide range of guidelines that are applicable to urological practice, e.g. those published by the European Association of Urology (EAU) or the AUA, other than to state that any urologist should have some working knowledge of those guidelines that pertain to his or her general and subspecialist interests. We discuss some of the ‘general’ guidelines that all hospital specialists should be aware of, as they cover the generality of surgical practice.

Patient confidentiality: ethical, legal and regulatory responsibilities

Confidentiality is fundamental to the trust upon which the doctor-patient relationship is founded. This is recognized in the Hippocratic oath, the UK NHS Confidentiality Code of Practice [1] and more recently in the NHS Constitution [2]. A duty to respect confidentiality is the subject of clear guidance from the General Medical Council (GMC) [3], whilst the legal obligation to respect confidentiality is determined by case law and enshrined in statute.

Thromboprophylaxis for patients at high risk of VTE

1912 www.thelancet.com Vol 371 June 7, 2008 Offi cer’s guidance advises VTE prophy laxis only in patients whose length of stay is predicted as likely to be more than 4 days. We feel that this recommendation adds uncertainty into clinical decisions. The admitting physicians were only able to predict a length of stay in 47% of the 135 patients, who otherwise met thromboprophylaxis guidelines. We have now changed our admission proforma to include VTE risk assessment as a matter of routine in all patients admitted with an acute illness, and hope that this improves the rate of VTE prophylaxis.