[2025] EWHC 2025 (KB)

During the second consultation on 20 April 2019, the claimant said that the defendant told her that the biopsy had confirmed haemorrhoids and that this was the cause of the bleeding. She said that the defendant told her that the haemorrhoids needed removing and once removed this would stop the bleeding and she would feel much more comfortable. She said that the defendant recommended a ligasure haemorrhoidectomy under general anaesthetic which he said was the definitive surgery and his preferred method. He briefly explained how the procedure would be carried out. She said that the defendant explained that the most common side effect was post-operative pain which would last approximately 3 weeks, which would be managed with Movicol and pain killers. He also said that there might be some minor post operative bleeding, discharge and incontinence after surgery which would resolve fairly quickly. The claimant said that she was keen for the bleeding to be stopped so she agreed to the surgery which was booked in for 13 June 2019.

The claimant said that the defendant did not explain at any point during this consultation that he had seen an anal fissure during the flexible sigmoidoscopy. She said that a potential anal stenosis complication was not discussed with her, nor were alternative, non-surgical methods of stopping her rectal bleeding. She said that if these had been discussed, she would have taken time to consider them and would have asked for full details of such alternative treatments.

The claimant agreed that the defendant had given her the EIDO Healthcare leaflet and that she had taken it away with her and read it. The EIDO leaflet is a four-page document which explains what haemorrhoids are, the benefits of surgery, the alternatives to surgery, what the surgery involves and what surgical complications can happen. On page 1, under the heading “Are there any alternatives to surgery” the leaflet states:

The defendant said that he did address alternative treatment methods with the claimant including conservative measures such as diet and banding. The alternatives to surgery that he would have discussed with the claimant were those contained in the EIDO leaflet.

However, he told her that dietary changes were unlikely to assist with Grade 3 haemorrhoids and that banding for Grade 3 haemorrhoids had a variable success rate and was not a definitive treatment as it either doesn’t work at all or it works for a while and then the problem returns. He said that the claimant was keen to proceed with surgery.

He said that the fact that his letter records “we had a discussion about haemorrhoid surgery, and she is keen to proceed” meant that he had a discussion with the claimant about non-surgical options as well as surgery. If they have discussed conservative measures but the patient is keen to proceed for surgery, he writes in clinic letter “keen to proceed” – and then provides the EIDO leaflet so that the patient can also read about alternative measures. This was his standard practice, “I don’t perform surgery in benign cases without discussing alternative methods.” He said that he appreciates that patients may not remember everything in clinic so it is his standard practice to give them the EIDO leaflet so that they can read through it, and if the patient has any issues or concerns, then they can make another appointment or raise these on the day of surgery.

It was put to the defendant that if the claimant was responding to Movicol then that pointed towards conservative treatment in the first instance. He said that she had already had a period of conservative treatment with Movicol, and the bleeding symptoms were still persistent. It was put to him that whatever grade the haemorrhoids were, the recommended treatment should have included the option of conservative (non-surgical) treatment. He said that the alternatives to surgery should be given but whether they would be recommended would depend on what grade the haemorrhoids were and how much the patient wanted their symptoms to clear up.

In December 2021 and February 2022, the claimant had consultations with Mr Thompson. He told her that if her haemorrhoids were the cause of her bleeding then these could have been treated by injections or banding (this was on the basis that at this time, Mr Thompson’s opinion was that the claimant’s haemorrhoids were only grade 1). The claimant said that if these options had been discussed with her by the defendant, she would have tried these as for her, surgery was a last resort.