An unnecessary procedure

01 February 2008

Mrs P attended a local GP with her four-year-old son, Ross, who was suffering from a painfully inflamed glans penis. The GP diagnosed balanitis and prescribed antibiotics. Although it was the first time Ross had presented with the condition the GP decided to refer the boy to a consultant to consider circumcision.

Mr L, the consultant, had no obvious specialist experience in circumcision but decided the procedure was warranted and arranged for Ross to be admitted at an early opportunity. Mr L performed the circumcision and Ross suffered substantial pain on recovery and had to be treated for antibiotics for post-operative infection. Later Mrs P became very dissatisfied with the result upon healing and claimed that Ross now suffered teasing from his friends.

Analysis and outcome

Mrs P contacted her solicitors and Mr L received a letter of claim alleging negligence. It was stated that he was at fault for first accepting the referral from the GP without having the necessary expertise and for opting for circumcision without sufficient cause. Ross had suffered only one episode of balanitis and other more conservative options should have been considered.

Mr L was also found at fault in the conduct of the procedure. A medical expert hired by Mrs P's solicitors reported that although the circumcision was generally well healed, the suturing had been performed 'clumsily' resulting in an untidy appearance and an increased risk of meatal stenosis, painful erections and phimosis.

The case was settled out of court.

Key points

• Ensure that surgery is warranted by evidence of current accepted practice.
• Ensure that the patient or patient representative provides fully informed consent.
• Discuss all potential complications prior to surgery.
• "Recognise and work within the limits of your competence." (GMC 'Good Medical Practice')

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