Wouter Leclercq

Chapter 8 130 RESULTS A total of 11376 malpractice claims were filed between 1 January 2004 and 31 December 2013 (Figure 8.1). 978 (8.6%) of these cases involved allegations of deficiencies in the informed consent process. Nearly 70% (676/978) concerned surgical specialties. 15% of the files were re-reviewed by the second reviewer and conflicting results were discussed until consensus was reached (kappa=0.57). A random sample of 245 claims (37%) was eligible for analysis. From the online databases 661 MDB decisions were retrieved: 117 concerned surgical specialties of whom 69 MDB decisions met the inclusion criteria and were analysed. General characteristics In more than sixty percent of the malpractice claims and MDB complaints the complainant was female (Table 8.3). Most claims and complaints were filed against medical specialists. In 39% of claims and 28% of MDB decisions, informed consent was the main subject. Most patients complained about the lack of informed consent in relation to the occurrence of a postsurgical complication. More than 10% of patients were (also) dissatisfied by the doctor’s behaviour and communication. In addition to the information complaint, there were often allegations about the insufficient documentation of the SIC process in the medical file. Cases per medical specialty In our study, four surgical specialties accounted for 82% of all claims and lawsuits concerning SIC (Table 8.4). This was representative for the overall group of 676 malpractice claims in which these specialties accounted for 84%. Relatively, most malpractice claims were against orthopaedic surgeons. Plastic surgeons had the highest rates of informed consent disputes. Patient’s allegations In 67% of claims and MDB decisions the primary allegation concerned a particular risk or complication of the treatment that had not been disclosed by the physician (Table 8.5). The second most common allegation involved insufficient information about the characteristics of the treatment, especially about the medical technical aspects, which doctor performed the procedure or which alternative treatment options were available. In 15% of claims and MDB decisions the treatment was ruled to have been performed without the patient’s (full) consent. When a resident was involved in the treatment process, patients claimed significantly more about which doctor performed the treatment (P<0.001).