Dr Jenny Edge enlightens us on how a UK surgeon was imprisoned for over-operating and doing unconventional operations on breast cancer patients.
Last month, I had the privilege of attending The Association British Surgeons (ABS) conference in Birmingham, UK. It was an excellent conference. There was a session devoted to bullying in the workplace. This is quite unusual for a surgical conference, but what came out of it was definitely food for thought. It revolved around a UK surgeon, Dr Ian Patterson.
Dr Ian Patterson
Ian Patterson was a surgeon working in the Midlands, UK. He has recently been convicted for over-operating and doing unconventional operations on women with breast cancer. He has been sentenced to 20 years in prison.
What went wrong?
The National Health Service (NHS) is very regulated. Much more regulated than the health service in South Africa. Although, Dr Patterson was guilty of several misdemeanours, his offences fell into three categories:
1. Over-managing and over-operating on women: he exaggerated their risk of breast cancer and sent them for too many investigations.
2. Making up an operation, called a ‘cleavage-sparing mastectomy’. It was a mastectomy that resulted in lots of breast tissue left after surgery. This clearly resulted in a more ‘natural looking’ breast as a lot of the natural breast tissue was left after the operation.
NOTE: Doing oncoplastic surgery is complex. As cancer surgeons, we must sometimes accept that removing skin over the area of the cancer will leave a scar in a less acceptable place. The most important thing about breast cancer surgery is the adequate management of the cancer. That should never be compromised for a more acceptable cosmetic outcome.
3. Not following protocols for diagnostic procedures. Ideally, all patients with breast cancer should be diagnosed without having surgery. An operative biopsy should only be done if the diagnosis cannot be made preoperatively.
How did this happen?
Anyone who has breast cancer is discussed at a multi-disciplinary meeting attended by oncologists, surgeons, radiotherapists, pathologists, radiologists, psychologists, nurse practitioners, etc. These meeting are highly structured. So, how did Ian Patterson manage to treat so many women in an unconventional manner for so many years?
He was a charismatic bully, who was not a trained breast surgeon nor a member of any specialist breast surgery organisation.
Bullying in the workplace
For many years, sexist or racist behaviour has been addressed in the workplace. Bullying has been harder to define. Harder to regulate. A comment made by a colleague may be interpreted as bullying by one staff member but not thought of as being offensive by another. There has been a culture of telling people to toughen up. An impression that the victim of bullying is to blame rather than the person doing the bullying.
Ian Patterson was reported in 2003 to hospital management. A report was commissioned and he was investigated by a head and neck surgeon. Not a breast surgeon. In 2007, he was reported again. He, was then, allowed to choose the panel who investigated him.
The whistle blower was noted to have “personal difficulties”. Dr Patterson was asked to refrain from doing unconventional treatment but could continue practicing.
At the end of the day, it was his patients who brought charges against him. He was found guilty and his work colleagues were criticised for not being more forceful in their objections to his management.
He has cost the NHS £17,4m so far. It is projected that it will cost £34m in total when all the claims have been settled. One thousand two hundred patients’ management needs to be reviewed.
How can we learn from this?
Wherever possible, choose a surgeon who specialises in breast cancer management and regularly attends breast conferences, and ensure the surgeon works in a multi-disciplinary team.
MEET OUR EXPERT – Dr Jenny Edge
Dr Jenny Edge is head of the breast and endocrine surgical unit at Tygerberg Hospital. She is the founder of the Breast Course for Nurses.