When Things Go Wrong In Urology: Reflections to Improve Practice

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