A 58-year-old gentleman attended a surgeon having hurt his hand. Incidentally, he was found on examination to have damage to his radial collateral ligament at the metacarpophalangeal joint of his right thumb, and this – it turned out – actually occurred as the result of an incident 12 years previous. He was complaining of some intermittent pain in the area of the joint, especially on grasping.

The injury to the rest of his hand was treated over the next year, and on review, the plaintiff still complained of problems with the thumb, unrelated to the recent injury. No further X-rays were taken, and the possibility of surgery was discussed along with potential complications, such as ending up with a painful stiff joint.

The procedure was carried out as a day case; he healed quickly and attended for hand physiotherapy.

Unfortunately, over the next few years, he developed increasing pain in the joint of the thumb, and X-rays taken three years after the surgery showed severe osteoarthritis in the area with the loss of joint space, as well as bone cysts. The plaintiff took a case against the surgeon, saying that he in fact made matters worse, and a medico-legal report obtained from a senior hand surgeon stated that, had the patient been sent to him, he would have suggested fusion of the joint as opposed to repair of the ligaments in the volar plate. However, he did recognise that a reasonable body of respectable opinion would have offered the repair of the ligaments as a first option.

In the event, there was no case to answer. The joint was not noted to be severely arthritic at the time of surgery, and over the subsequent few years, the arthritic process had developed, possibly now requiring fusion of the joint.

The main point here is that just because a surgeon, however senior in the speciality, would possibly have carried out a different procedure, the fact that – as the expert fully acknowledged – a reasonable body of medical opinion would have repaired the ligaments first meant that there was no sub-standard advice or care by the doctor involved.

Although it did not happen in this case, there is a warning to medical experts not to allow their own preferences in treatment to be regarded as the only method of treatment that other senior doctors may follow. Any comment on the standard of care in a particular case has to be balanced with what is thought to be reasonable throughout the speciality.

MDU figures for 2022 show that fewer than one in six actions in medical negligence actually succeed, with the vast majority failing on the grounds of causation. It must be remembered that subsequence is not the same as consequence.

Initial screening is, therefore, essential to manage client expectations at an early stage. This avoids unnecessary effort and costs for all concerned. Too many cases are taken to court with no chance of success. This is stressful for both the client and their legal adviser, and indeed for the medical personnel involved.

For fast and effective screening of all potential medical negligence cases, contact Peyton Medico Legal Services now on +44 (0)28 87724177 or email [email protected]