Errors in Colorectal Surgery

Surgery has five unique characteristics that set it apart from any other medical specialty 1. Surgery harms before it heals 2. It penetrates the patient ́s body and thus is highly invasive. According to the judgement of Judge Benjamin Cardozo in Schloendorff v Society of New York Hospitals (1914): “a surgeon who performs an operation without patient ́s consent commits an assault” 3. It is fallible, which means that surgery is predisposed to human error. Increased awareness on this topic has been developed since the Institute of Medicine “To Err is Human” was published (10) 4. A surgeon ́s decision making process is usually performed under circumstances of uncertainty 5. It is prone to risks and complications The surgeonpatient relationship is built upon trust, so it is preferable to speak about it from a fiduciary viewpoint, not as a contract. As John Gregory stated during the XVIII century, the physician (8): must be in a position to know reliably the patient ́s interest should be concernid primarily with protecting and promoting the interests of the patient should be concernid only secondarily with protecting and promoting his or her own interests The surgeon-patient relationship is attained and perfected throughout the process of the surgical informed consent, which includes the following elements: 1. Preconditions: competence and voluntary attitude of the patient 2. Information: disclosure and recommendations by the surgeon and the patient ́s understanding of the information provided. 3. Consent: decision-making (acceptance or refusal), communications, registration, and the patient ́s authorization to proceed. Errors in this process due to the lack of truthful and sincere information can result in later claims in the legal system.