When Things Go Wrong In Urology: Reflections to Improve Practice

Description

This book provides a guide on how to navigate and avoid medico-legal problems associated with the management of patients with urological diagnosis. Each chapter focuses on a different medical situation related to urology and discusses how they can be managed. The book aims to utilise the experience and understanding of its authors to help its readers manage and avoid medico-legal issues. This book is relevant to urologists, allied health professionals, nurses, physiotherapists, physicians, and medical legal practitioners. Preface Acknowledgements Contents About the Editors Abbreviations 1: Introduction to Medical Law 1.1 A Practical Approach to Medicolegal Law 1.2 Legal Terms and Meanings 1.2.1 Medical Laws 1.2.2 The Common Law 1.2.3 Quasi-Law References 2: Clinical Negligence and Malpractice 2.1 Litigation in Urology 2.2 Professionalism 2.3 Patient Rights References 3: Medicolegal Pitfalls 3.1 An Approach to the Ethical Problem 3.2 The Patient Pathway 3.2.1 History Taking and Examination 3.2.2 Chaperones 3.2.3 Diagnostics 3.2.4 The Multi-disciplinary Meeting 3.2.5 The Operation 3.2.6 The Post-operative Period References 4: Communication in Healthcare 4.1 Discussions with Patients 4.2 The Angry Patient 4.3 Managing Patient Expectations 4.3.1 Information 4.3.2 Time Pressures 4.3.3 Patient Anxiety or Depression 4.4 Communicating with Staff References 5: When Communication Goes Wrong in Medicine 5.1 Between the Doctor and Patient 5.2 Between Healthcare Professionals 5.3 Between Healthcare Professionals and Family Members 5.4 Communication Teaching 5.5 Future of Communication References 6: Communication Between Different Levels Within a Team 6.1 Tools Available for Communication 6.2 Prevention of Medical Errors 6.3 Know When You Are Out of Your Depth 6.4 Always Maintain Patient Safety 6.5 Reactions to Negative External Factors 6.6 Work Closely with Your Team 6.7 Always Be Accessible 6.8 Dealing with Conflict 6.9 Why We Need to Have Good Communication Between All Team Members 6.10 Managing Juniors in Difficulty 7: Communication Within a Theatre Team 7.1 Rationale for Effective Communication 7.2 Elective Theatres 7.3 Confidential Enquiries into Perioperative Deaths (CEPOD) Theatre (‘Emergencies’) 7.4 Pre-operative Communication 7.5 Anti-coagulation 7.6 ‘Nil by Mouth’ 7.7 Assessment 7.8 Recommendation 7.9 Peri and Intra-operative Communication 7.10 “STARTING” 7.11 “STOP” 7.12 “Closing” References 8: Digital Communications in Urology During the COVID-19 Pandemic 8.1 Introduction 8.2 Methods 8.3 Results 8.4 Discussion 9: Legal Records and Documentation 9.1 Operation Notes 9.2 Delayed Presentations and the Importance of Documentation References 10: Consent 10.1 Consent Post-Montgomery 10.2 Case 1: Informed Consent—Chronic Scrotal Pain Post-vasectomy 10.2.1 Chaperones and Documentation 10.3 Case 2: Failure of Vasectomy 10.3.1 Communication and Pre-operative Counselling 10.3.2 Bruising, Scrotal Swelling and Haematospermia 10.3.3 Early Recanalisation 10.3.4 Late/Delayed Failure Causing Pregnancy 10.3.5 Surgical Technique 10.4 Case 3: A Nephrectomy Performed Without Consent 10.4.1 Communication and Selection of Management 10.5 Case 4: Failure to Inform About Outcomes and Alternative Treatments for Treatment of Bladder Outflow Obstruction 10.5.1 Inadequate Investigation, Discussion of Treatment Options and Consent 10.6 A Word on Circumcision and ‘Minor Operations’ 10.7 Summary References 11: Administrative Problems 11.1 The Referral 11.2 The Clinic Appointment 11.3 Requests and Investigation Results 11.4 Discharge Plan References 12: Prescribing References 13: Diagnostics 13.1 Case 1: An Unnecessary Operation 13.1.1 Appropriate Investigation and Follow Up of Results 13.2 Case 2: Missed Prostate Cancer 13.2.1 Appropriate Follow Up of Patients and Handover Between Clinicians 13.3 Case 3: A Missed Testicular Torsion 13.3.1 Diagnostic Evaluation with Ultrasound 13.3.2 Clinical Suspicion and Surgical Experience References 14: Operating Theatre Issues 14.1 Intra-operative Equipment 14.2 Intra-operative Communication 14.3 Perioperative Complications 14.4 Theatre Organisation 14.5 Surgical Emergencies References 15: Human Factors in Healthcare References 16: Managing Difficult Seniors 16.1 Managing Direct Conflict 16.2 Being a Female in Medicine 16.3 Fixed and Growth Mindsets in Medicine 16.4 What to Do when Training Fails 17: Leadership in Medicine 17.1 Development of Leadership Under Pressure 17.2 Leadership Styles in Medicine 17.3 Coaching and Mentoring as Part of Leadership 17.4 A Supportive Leader Can also Be a Supportive Team Player 17.5 Good Leadership Is Built on Trust 18: Managing a Complaint 18.1 The Complaints Procedure in the NHS 18.2 Responding to the Complaint References 19: The Anatomy of Failure and How to Avoid It 19.1 An Introduction to Failure 19.2 Creating the Case for Change 19.2.1 Do I Have Clear Goals? 19.2.2 Am I Sufficiently Focused? 19.2.3 Do I Have a Clear Action Plan? 19.3 Have I Overcome My Mental Barriers? 19.4 Plotting a Course for Success 19.5 What Is Coaching and Mentoring? 19.6 Coaching 19.7 European Mentoring and Coaching Council (EMCC) Definition of Coaching 19.8 Mentoring 19.9 European Mentoring and Coaching Council (EMCC) Definition of Mentoring 19.10 Roles and Responsibilities within the Coaching and Mentoring Process 19.11 The Benefits of Having a Coach in Your Life References 20: Raising a Concern in Training 20.1 General Medical Council Duties of a Doctor 20.2 Raising a Concern in Training 20.3 Reporting 21: The GMC Investigation 21.1 The Provisional Enquiry 21.2 The Investigation References 22: Approach to GMC Investigations, How to Handle Them and What to Do 22.1 Initial Consideration and Referral Allegation 22.2 Before the Hearing 22.3 The Hearing 22.4 Dishonesty-Forging Patient Notes 22.5 Misconduct; Falling Short of Standards 22.6 Sexual Relations with Patients 22.7 Sanctions 22.8 Race and the GMC 22.9 Mr. Omer Karim’s Case 22.10 Implications of the Case 22.11 DEI/Diversity, Equity and Inclusion and the GMC References 23: Burn Out in Medicine 23.1 Definition of Burn Out 23.2 Contributing Factors to Burn Out 23.3 Recognition of Burnout 23.4 Mindfulness References 24: NHS Whistleblowing 24.1 Is it Safe to Raise Concern and Be Whistle Blower? 24.2 Current UK Law to Protect Public Interest 24.3 Doctors in Training and their Whistleblowing Protection 24.4 GMC and Whistleblowing 24.5 Duty of Candour and Harm 24.6 My Summary and Conclusion References Index