The doctor-patient relationship is of paramount importance in the course of consultation and treatment. The medical practitioner expects the patient to comply with treatment, and the patient expects the doctor to be competent. However, in reality, the relationship between doctor and patient is not always as perfect and harmonious as one might anticipate. Especially when complications of treatment appear, grievances may emerge and accumulate.

John, a middle-aged man with a past history of anxiety disorder, was admitted to hospital for surgery. The surgery itself was rather simple and could be performed with local anaesthetic. However, due to his apprehension of pain and anxiety, John demanded the procedure be done under general anaesthetic. The surgeon summoned an anaesthesiologist to explain the risks and benefits of general anaesthetic. After listening to the explanation, John decided to go for the general option.

The risk

During the pre-op work-up, the anaesthesiologist told John that he had a loose incisor tooth, which John admitted he had known about for some time. After reminding the doctor to be careful about the procedure, the anaesthesiologist quickly assessed the tooth and believed that it was still strong enough to withstand the general anaesthetic and intubation, and he continued with the procedure.

The surgery was successful and uneventful. After the surgeon left, the anaesthesiologist stayed with the patient in the recovery room until he determined the patient was conscious enough to remove the tube from his mouth. After that, the anaesthesiologist checked the loosened tooth again and documented his findings before he left. However, when the patient woke up from his general anaesthetic, he noticed his tooth was gone, nowhere to be found.

Mediation

The patient immediately requested an explanation from the anaesthesiologist and the hospital. After hearing the former’s account and finding the explanation far from acceptable, the patient filed a legal action against him. The anaesthesiologist believed he had done nothing wrong, but was worried about the legal consequences and the effect it might have on his reputation. At the same time, a medic friend of the patient engaged in dialogue with both sides and mediation was suggested. It was understood that participation would be voluntary and, if no settlement was reached, they could pursue litigation to resolve the conflict.

After the incident, communication had broken down between the doctor and the patient. Neither side wanted litigation, but it seemed that it was the only way to get the two sides to talk to one other. In the mediation, communication started again. The anaesthesiologist defended himself, saying that he had explained the risks to the patient and had taken all the  necessary precautions to prevent incidents from happening. He also said he had no idea what happened to the tooth after he left. The patient explained that, from his perspective, the loss of the tooth was one issue, but not at that moment his main concern. The most pressing need for him was what he should do with the empty socket left by the lost tooth.

Through the use of “agenda setting” and “issues to be discussed”, it was quickly established that the doctor and the patient had very different concerns. The mediator identified that the doctor wanted no admission of wrongdoing and did not want the case to go public. But he sympathised with the patient’s cosmetic grievance and was willing to assist him in fixing a denture. The patient had known from his dentist beforehand that the tooth was seriously destabilised by periodontal disease. The problem was he lacked the funds to fix the dentition. The patient also did not want legal action and had no intention of destroying the reputation of the doctor.

With the use of joint session and caucus, the mediator was able to sort out the issues that most concerned the two parties. In the end, the mediator helped them to generate a list of options that were acceptable to each, and to narrow them down to an agreement. The doctor would assist the patient by introducing a list of dentists for the patient to choose from, and he would pay the dentist directly, up to an agreed ceiling. The patient also accepted there was no wrongdoing on the doctor’s side, and he would not pursue the case further.

Conclusion

Many disputes can arise in the health care sector for different reasons but need not always result in litigation. Where professional standards are not an issue, mediators can help the parties understand each other’s concerns and needs and create options acceptable to both.

This article appeared in the Classified Post print edition as Medating to resolve a post-operative complication.