Patients "Carry the Can" for Poor Varicose Vein Surgery

When a patient has been referred by a family practitioner or private medical insurance company to a specialist, and a substandard result occurs, who takes the blame?

Recently I saw a charming 27-year-old lady with recurrent varicose veins in both legs. Two years ago, she had gone to a local "vein clinic" where a doctor had performed a scan and told her she could have the latest laser treatment for her veins. Happy she was having the latest techniques, she consented to go ahead with the procedure. Six months later her varicose veins started reappearing.

With progressively worsening varicose veins, she conducted an extensive research on the Internet and decided to come and see me to find out what had happened to her in her previous procedure and what was possible to put it right.

Duplex ultrasound scanning carried out by our specialist vascular technologists showed that the patient had two major veins in each leg causing her varicose veins. Unfortunately, the clinic she had been to previously (where the doctor himself had performed the scan) had only identified one vein on each leg that needed treatment leaving the second veins untreated, causing her recurrent varicose veins. Even worse, the ultrasound scan highlighted that where previous treatment had been attempted, the patient should have had between 35 to 40 cm of her veins closed with the laser, however only 2 cm had been closed successfully on one leg and on the other, 7 cm.

To prevent any further recurrent veins, to treat the veins previously missed and to rectify the poorly treated veins, we put together a treatment plan that would help solve the problem in the long term. Then came the rub ... Not surprisingly the young lady pointed out that she had spent a lot of money on her last treatment which had clearly not been successful, and asked whether she should be in a position to get her money back.

Unfortunately the law in the UK, and I assume in many Western countries, recognises that medicine is not a precise science and outcomes cannot be guaranteed. It is well-known that different doctors get different results, hence the insistence of the government that doctors should publish their results over the last decade. (I have previously written about this here)

As such, patients are unable to get their money back or sue doctors for poor results and can only take such redress if they can prove the doctor or clinic was negligent. Merely being not very good at scanning and not very good technically at treating veins unfortunately is not seen as a reason for redress. This means that any of the thousands of patients in the same position as this lady are unable to receive compensation despite having very early recurrences due to inadequate assessment and treatment. As the law sees it, it was their choice to go ahead with their chosen doctor or vein clinic and they have given their consent to the procedure being done.

The situation is bad enough when a patient consents to a procedure in good faith because they have been taken in by a flashy website or the convenience of a local clinic. But it is compounded when the patient did not choose where to go themselves, but accepted referral from their family doctor or their medical insurance company, assuming that these professionals are "in the know".

Of course very busy family doctors are unable to keep up with who is at the top of their profession and provides the best results in every speciality - there are just too many specialists and medical conditions. Hence they usually just refer their patients to whoever is the local "expert". Private medical insurance companies clearly only refer or recommend doctors that they "recognise" - which usually means that they have accepted a low fee schedule. One has to always think why a specialist might do so.

So when a patient has been referred by a family practitioner or private medical insurance company to a specialist, and a substandard result occurs, who takes the blame? Once again, despite the patient having been directed by the family practitioner or private medical insurance company, it is the patient themselves that "carries the can". The legal position appears to be that if they consent to the procedure being performed by the person they have been referred to, then they accept the responsibility for any suboptimal result, provided it stops short of negligence.

With family practitioners and private medical insurance companies not always able to provide patients with the best recommendations for their treatment, it is imperative that patients themselves do their research into which doctors or clinics they want to treat them. They also need to be aware that before undergoing any treatment, if they do end up with a sub-optimal result, in many cases it is unlikely that the doctor or clinic will take responsibility for any corrective work that needs doing in the future - even if they were directed by a doctor or insurance company to that practitioner or clinic in the first place.