Wouter Leclercq

Chapter 8 134 DISCUSSION To the best of our knowledge, this is the first study in the Netherlands that analysed the deficiencies in the SIC process in malpractice claims and MDB decisions from a patient’s point of view. This analysis might be helpful in future projects enhancing the SIC process. In the current study most files involved information elements of SIC. Improved understanding of patient’s preferences and expectations regarding preoperative information contributes to a better adjustment of the information and thereby the quality of care. 15-17,34 There is, however, a gap between the information doctors usually share before surgery and the information patients actually want to receive. Surgeons think patients desire more extensive information on the cause, effect and prognosis of the disease, while patients actually wanted more information on the operation characteristics and risk or complication rates of a specific surgery. 35 Our study affirms this, as 67% of the patients felt not properly informed about a particular risk or complication of an operation and 30% felt not adequately informed about the (technical) characteristics of the surgery. The predominance of cases alleging undisclosed risks in SIC is striking. The most accusations in this study involve frequently performed elective or aesthetic surgical procedures 29,36,37 , This seems plausible, as extensive risk disclosure tends to matter more for patients undergoing elective surgery. Next to patient’s expectations, good communication plays a major role in the perception of care. This is confirmed by the fact that the majority of legal cases is caused by failures in communication, rather than failures in treatment. 1,30,38-41 In our study at least 10% of patients were dissatisfied by the doctor’s behaviour and communication. They felt their problems were not taken seriously or the doctor did not have enough time. According to recent studies, Dutch orthopaedic, plastic and general surgeons have poor knowledge and skills regarding SIC. 6,32 If staff is well trained, adequate information provision and consent recording is less at risk. Our study had some shortcomings. Our results were based upon a random sample of Medirisk cases and our analysis did not include the claims which were not covered by Medirisk. Not all malpractice and MDB cases from this period were fully completed and publicised. This might had some unknown selection bias effects. It was also impossible to specify the lawyer’s judgment on SIC. We tried to compromise this by only analysing the complaints in which SIC was the main complaint. Nevertheless this study provides clues to enhance the SIC process. Doctors should discuss all relevant risks, that prioritize patient’s preferences. 6 In the Netherlands, 39% of the surgeons claimed that there was no institutional standard operating procedure (SOP) on quality or quantity of preoperative information. 6 It appears useful to standardize the SIC process and specify factual risks for different treatments. Moreover, it is important to enhance patient’s understanding, as recall of informed consent information is poor. 42‑49 Improving information transfer to patients with currently popular interventions as shared decision making (SDM) and e-health projects might be beneficial and should be further