Reviews

The Spine and Medical Negligence

R W Porter

Bios Scientific, £19.95, pp 200

ISBN 1 85996 126 6

Rating:

Since 1991 the cost of medical negligence in the United Kingdom has risen fivefoldit costs the NHS over £300m a year. Fortunately, there is no evidence of any fall in clinical standards. The proportion of claims that are settled with payment of compensation to patients has in fact fallen from 34% in 1975 to 25% in 1997.

The medical profession cannot afford to be complacent, however, and even less so can orthopaedic surgeons, who regularly feature at the top of tables of claims. Clinical risk management is here to stay, and NHS trusts are adopting programmes of risk management to reduce the number of accidents to patients.

Professor Porter has done his colleagues great service in setting out the important issues surrounding consent, counselling, operative technique, and pitfalls where mismanagement can cause major neurological damage and costly disability.

The chapters on why patients sue, the legal process, informed consent, and risk management are worthy of any medicolegal textbook, but I was particularly taken with the many case reports emphasising the dangers behind clinical scenarios.

Four messages emerge: reliance on conservative surgery when anything more could not guarantee a better result; the importance of patient selection for difficult revisional surgery, coupled with the choice of an experienced centre; the great need for informed consent about difficult and highly technical procedures; and the obligation to educate patients about the reality of medical practice, as medicine cannot completely remedy every clinical problem.

Responding to a lawsuit may be one of the most stressful times of a doctor's life. Some allegations will be ill-founded because the undesirable outcome stemmed from the natural course of the disease or from a well known and unavoidable complication, but much morbidity and the consequent litigation is avoidablehow nice to be told how in such a measured and effective way.

Patrick Hoyte, deputy head of advisory services. 

Medical Defence Union, Manchester