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College decision: Talking to patients about a complication
An article for physicians by physicians
Originally published December 2007
IL0740-1-E

Of interest to all physicians

Although a young woman in her first pregnancy had initially progressed well in labour, she was failing to progress in the second stage. She had been pushing for nearly three hours when the obstetrician on call attended. He had never met this young woman before and advised, as she was so tired, he should deliver the baby by forceps. Forceps delivery of the head was followed by shoulder dystocia, which was also successfully managed.

Inspection of the perineum and vagina revealed a fourth degree tear. The delivering obstetrician repaired this using a standard procedure, and transferred this young woman back to her attending obstetrician for postnatal management. Neither physician discussed the tear with the patient.

Unfortunately, the tear did not heal well and the patient needed further surgery.

The new mother complained to the provincial/territorial regulatory authority (College) about the on-call physician. She had three concerns:

• if she had known the forceps might cause a recto-vaginal tear, she would have insisted on a caesarean section;
• the postpartum care was unsatisfactory; and
• no one had told her about the serious nature of the tear, or its possible long-term consequences.

The College had no criticism with the physician’s care regarding the first two complaints. However, it did have concerns about the lack of communication with the patient. The College stated that “best practice” would have been for the doctor to make sure, before the patient was discharged, she was made aware of the circumstances of the tear and repair, as well as the potential complications that might arise. It pointed out “patients are entitled to be informed of all aspects of their health care,” including a right to know about complications that have occurred.

The bottom line

When a complication occurs, it is important to decide who should discuss it with the patient, and when. Usually it will be the most responsible physician, but when more than one physician is involved, good communication between or among the physicians will help to ensure the patient receives both good care and adequate information.