Risk communication of surgery

A patient, Ms B, aged 50, saw surgeon Dr E for a 2 cm nodule in the head of the pancreas found on routine ultrasound screening. After doing blood tests and MRI scan, the nature of the pancreatic nodule remained unclear and Dr E told Ms B so. Ms B was told that the tests were inconclusive and ambiguous. She was given the alternatives of either waiting-and-watching, with repeated scans over months to see if the nodule changed, or go for surgery to remove the mass. The usual information about surgery, such as bleeding, infection, wound breakdown, deep vein thrombosis, heart attack and stroke were all disclosed to Ms B. She chose the surgery. The mass turned out to be entirely benign. However, there were complications of surgery leading to prolonged ICU stay and hospitalization and her hospital bill, which she had to pay for, was very high. Ms B subsequently mounted litigation against Dr E on the grounds that he had not told her specifically the details about the limitations of the blood tests and MRI and had she known that information, she would have understood that cancer was not likely and would never have consented to the surgery. She claimed that she is the sort of person who would have wanted to know all the details of medical tests, their accuracy rate and limitations, so that she can exercise her right of autonomy.

This case was originally designed for a November 2016 CENTRES workshop on the ECEG professional guidelines.