Important message for ophthalmologists about cataract surgery

Complaints are common about cataract surgery – CMPA and College have similar findings

The Canadian Medical Protective Association (CMPA) recently conducted a review of the complaints and litigation experience of its ophthalmologist members. The CMPA found that patient complaints mainly allege

  • inadequate assessment, and
  • lack of informed consent.

Cataract surgery was the most frequent clinical context.

The College urges all BC ophthalmologists to carefully review the CMPA findings which helpfully summarize the expected standard of care. These findings mirror the College experience.

In the above-referenced article, CMPA peer experts emphasize the importance of “… detailed, clear, and legible documentation of the medical and ophthalmic history…” and of assessment findings. Too often the record submitted to the College consists mostly of specialized ophthalmological shorthand, with little or no narrative detail. Records such as these provide no assistance to surgeons in defending their actions. The College Bylaws mandate a record detailing why the patient came, what was found, and what was done for every encounter. This is also an expectation of the courts.

The record of the consent discussion should authentically describe a conversation with the patient. The CMPA peer experts advise that this should include an opportunity for the patient to ask questions of the ophthalmologist. It is not acceptable to delegate the consent discussion to staff. Print materials, including signed consent forms specific to the procedure, may be a useful supplement, but not a substitute for a discussion with the surgeon.

Finally, the CMPA peer experts emphasize the importance of ensuring patients have realistic expectations. A common source of College complaints is a misperception on the part of patients that they will not require corrective lenses after cataract surgery. This is so common that the College suggests making a specific record of having advised that the patient “may still need to wear glasses” in every instance.

Two other issues frequently arise in College investigations of cataract complaints:

  1. Whether the manner in which fees are administered for services considered to be “non-insured” by the ophthalmologist meets expectations set out in section 16 of the Code of Ethics, which states:

    In determining professional fees to patients for non-insured services, consider both the nature of the service provided and the ability of the patient to pay, and be prepared to discuss the fee with the patient.
     
  2. Whether the elderly patient had the capacity to consent to the proposed surgery. Another CMPA article entitled “Is this patient capable of consenting” may be a very useful resource to registrants.

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