EAU17: Hurdles in managing renal cancer ‘Sleepless Nights’ session offers insights on legal pitfalls

Insights into the legal pitfalls and challenges of offering balanced and optimal treatments to kidney cancer patients were explored and debated in Plenary Session 1, a newly introduced format where a legal veteran subjected three urologists to intense cross-examination regarding their surgical strategies.

In a well-attended and applauded session, expert medical litigation lawyer Bertie Leigh (GB) put Professors Alex Bex (NL), Karim Bensalah (FR) and Vsevolod Matveev (RU) under intense questioning to elicit insights into the crucial decisions they made for kidney cancer patients.

‘’Each of these cases, in different ways, raises questions about the conventional ways of treating patients. As a lawyer I am particularly concerned about consent counseling and how patients are handled because these are very difficult positions for urologists to take,” said Leigh, as he stressed that doctors should be “recording their uncertainties in the way in which they communicate with patients.”

Mr. Tim O’Brien, as moderator, presented three cases with the first case involving a small renal mass (less than 3cm) in an elderly patient. Bex was first ‘in the dock’ as he presented his arguments for performing a renal tumour biopsy (RTB). Leigh, who specializes in medical negligence, pressed Bex on his rationale for RTB, to which Bex conceded that there are no reliable approaches for diagnosing an oncocytoma before surgery.

Leigh emphasized that despite the low statistics on risks and complications, patients view the matter in an altogether different way. The loss of a kidney or suffering the consequences of complications is traumatic for patients.

“Doctors should offer patients alternatives which are realistic to them, all of the options available to them, and must relay the information in a form that patients can understand,” added Leigh. “You must make records of the advice you give them. Doctors are diligent in recording the results of their investigations, but when it comes to recording their advice, they write nothing. If it’s not written down, it won’t stand up in court,” said Leigh.