“The last thing you need is to have an accusation of rape against you for putting a speculum in.”

This was according to Dr Liz Meyer, Medical Protection Society (MPS) consultant, in her lecture titled Medical Legal Issues Relating To Surgery, organized by the Wits Students’ Surgical Society.

Meyer said sexual assault and substance abuse were the main reasons why medical students were dismissed from the Health Professionals Council of South Africa (HPCSA).

“You don’t get erased very easily, but if you do, it’s also very difficult to get back.”

Some records taken from doctors' notes in Mpumalanga hospitals.

Doctors don’t always know best

Meyer said the mindset in the medical profession has changed over time to pay more attention to patients’ rights, autonomy and expectations.

Doctors have faced court charges in the past for not tailor-making consent specifically to patients. She said patients must be made to understand the “material risk” of the procedures they may face.

“If you are considering an amputation, a ballet dancer is going to feel different about what is relevant to her in consent, than to a person that is already bound in a wheelchair.”

Etienne Raffner, 5th year medical student and co-founder of the surgical students’ society, said students were taught about consent before anything else in their degree.

"No, no no, nurse! I said slip off his spectacles!"

Communication is key

Meyer said registration with the HPCSA is a responsibility to conform to its ethical code, and doctors must not be afraid to name and shame negligent colleagues.

“If there’s somebody whose actions and work causes you concern, you must do something about it or otherwise, you are going to have problems.”

Meyer said it is important for doctors to share information clearly, especially where there is a language or experience gap. Clinical notes could be used in court, and it can be “very embarrassing” if not written properly according to Meyer.

Medical indemnity is big business

The MPS, which provides legal support to its members and compensates harmed patients, paid out R800m in claims last year.

Membership fees range from R100 a year for interns, to R220 000 a year for gynecologists, because they are considered “high risk”.

Prof Martin Veller, head of the Wits department of surgery, said it was “silly” for students to go into the profession without indemnity, regardless of the cost. Veller said he pays R80 000 a year on medical indemnity insurance.

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