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Re: Things that puzzle me about PCa #7 in an endless series – malpractice
From my limited knowledge of professional malpractice and indemnity issues, it is not sufficient just to show or prove that you had a bad outcome.
It is more a case of "was the advice that you were given typical of the advice that would be given by a majority of practitioners working in that field of practice in the same circumstances?"
Therefore most doctors would be wary about suggesting active surveillance unless you had a very low grade cancer and ticked all the boxes for one of the accepted AS protocols.
And even if it would be hard to mount a successful case for medical malpractice, some people would still try, and doctors don't want the bother of having to fill in forms, write reports, attend lawyers offices, etc., even if the action was destined to be unsuccessful. Also, unsuccessful claims against a doctor's professional indemnity insurance are not highly regarded by the insurance company.
Even if AS was reasonably appropriate, it is far easier to do what most other doctors would do in the same circumstances, and that is to recommend definitive treatment "while there is still the window of opportunity for a cure".
In my case, I have made it clear that the choice for AS is my decision and my GP is happy to go along with it and continue to write out referrals for PSA tests and stuff.
Re: Things that puzzle me about PCa #7 in an endless series – malpractice
I think you missed the point. The surgeon said he was going to remove my prostate using the most advanced tool available. Despite using a magnified 3D vision system and computer assisted manipulators, he missed half of it. When my PSA didn't go down, he was unable to find the cause (remaining prostate tissue) that another doctor found right away. To me, that sounds like he made serious mistakes during and after the procedure.
Re: Things that puzzle me about PCa #7 in an endless series – malpractice
Paul, medical malpractice is interesting. It's not enough to violate best practices. although that's the first test, the second is proving that you had at least a 50% chance of better outcome if he had followed the standard. that's a really tough one to document. It's so much easier when the test is did he/she remove something he should not have - like the wrong kidney. Sounds like your care was terrible, just as was the case for my husband. My husband's outcome is widely metastatic cancer 4 years after being turned away from post surgical external beam radiation to the prostate bed by a radiologist who was anticipating distant metastases in spite of all evidence to the contrary. Of course I have to credit our belief in a substandard care system too.