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Case of the Month

Cryotherapy consent - medical case study

26 April 2012

BACKGROUND: Ms C is a diabetic and attends her GP, Dr N, complaining of pain in her right foot. Dr N examines the foot and diagnoses a plantar wart. He explains three different treatment options and the associated risks of infection and delayed healing due to her diabetes. He recommends liquid nitrogen treatment as he believes it to be the quickest and most efficient option and refers her to his colleague Dr E.

Dr E administers liquid nitrogen treatment on several occasions over a number of weeks but after the third application Ms C complains that the pain has returned. Dr E administers a final treatment of cryotherapy and refers Ms C to a podiatrist who diagnoses her with infection in her foot and prescribes a short course of antibiotics.

At a follow-up appointment with the podiatrist two weeks later, the consultant identifies a deep cutaneous slough on Ms C’s right foot as a result of the repeated liquid nitrogen treatment and a foot ulcer. The ulcer worsens and eventually requires her to be admitted to hospital for treatment of the infection. Ms C’s foot does not heal for another 10 weeks and causes her considerable pain when standing or walking. Once the infection clears, she is left with a residual area of impaired sensation on her right foot.

Ms C files a claim of clinical negligence against Dr E alleging that he treated her without explaining the risks. While Dr N is a member of MDDUS, Dr E is represented by another indemnity organisation.

ANALYSIS/OUTCOME: Representatives of Dr E contact MDDUS to query the role of Dr N in the initial consultation and referral of Ms C. They question whether Dr N gave Ms C appropriate advice and whether he sufficiently explained all the available treatment options and their associated risks.

An MDDUS medico-legal adviser contacts Dr N asking him for an account of his involvement in the case and, in the absence of a detailed medical note, what his normal practice would be in such consultations.

Dr N confirms that his normal practice would have been to carefully explain the associated risks of all three treatment options, taking into consideration Ms C’s diabetes.

MDDUS informs Dr E’s representatives of Dr N’s position and confirms that he will have no further involvement in the claim.

KEY POINTS

  • Clearly explain treatment options and associated risks, taking into account existing conditions such as diabetes, when referring patients
  • Ensure patients referred to you for treatment understand treatment and associated risks before carrying out the procedure
  • Take clear, comprehensive notes of patient discussions and agreed treatment plan