MEDICO-LEGAL PRACTICE

• My first medico-legal report was carried out in 1981. Remarkably it was a matter based in the United States which is an intriguing story in itself. This kindled an interest which has blossomed over the years and been maintained. I have kept myself up to date with the changes in medico-legal practice. The Woolf reforms assisted to some extent with focusing attention on style and content. Without being too controversial, I do perceive that there were other aspects of the reforms that could have been covered that would have helped the whole process as discussed in a separate article.

   

I receive between 150-300 new instruction each year. I am always pleased to discuss any case with those instructing in order to facilitate the knowledge base and advise as appropriate. I do not routinely take on criminal instruction but have been involved in some high profile cases in the past. I do however frequently give pro bono advice in order to assist. A good example of this has been a number of individuals charged with tragedy in the setting of them having a first blackout or not having been advised appropriately with regard to the driving regulations. Regrettably it is not possible for any busy established private doctor to give the time that is needed within criminal matters at the rates of fees that are currently allowed. The same applies regrettably to coroners court matters as well.

 

Within the world of personal injury, my instructions are marginally more now from Claimants than Defendants with a small number of joint instructions still. Within the arena of medical negligence, I would seem to be equally instructed by both Claimants and Defendants. My medico-legal experience also includes industrial tribunals, matrimonial disputes, every type of capacity discussion and other matters involving the family division, and also disability discrimination. I have also undertaken many assessments with regard to complex insurance benefits.

 

My Research Group has also had a keen interest the way that experts are being targeted rather than cases being tried on their merit. It seems for instance that if there is a fragility to say a Claimant case, a lot of focus has been on undermining the expert opinion which I am sure Lord Woolf never intended. There has also been a lot of concern over a recent view that there is a condition known as “subtle” brain injury which is somehow worse than much more severe brain injury and that clinicians and experts do not recognise this for what it is. No one is saying that any degree of head or brain injury is good or that people may not have residual symptoms, but with decades of managing such people in clinical practice with appropriate help they get better usually rapidly, though some people need more help than others. The problem again with medico-legal practice, is that if one specialist holds a specific view, although they could well be in the serious minority of neurosciences opinion, given that it is a 1 versus 1 process, so much then depends on the skills of the barristers rather again than the knowledge of how the brain gets it wrong. As brain injury is such a fundamental part of neurological practice, I do find it rather challenging that people with moderate or severe brain injury are often having to prove their challenges more than ought to be the situation.

 

I am sure any lawyers reading this site will know, but a busy clinical Neurologist will find one third of neurological clinical referrals are for headaches or pain management if that is an interest. One third of the referrals clinically would be for people who have fits, faints, and funny turns and then the rest of neurology will include conditions like multiple sclerosis, the commonest disabling disease of young adults in the UK, Parkinson’s Disease, Stroke, Dementia, peripheral neuropathy and then a massive range of other diagnoses which are said to be more than all the diagnoses in the rest of medicine put together. I still receive between 500 and 750 new clinical referrals each year together with significant numbers of pro bono advice to colleagues. This is now a reduction compared to the more than 1000 – 1500 clinical referrals that I have had over many years deliberately done to create a better work/life balance.

 

Unfortunately, people with neurological problems have always faced under funding and a lack of resource in the UK. It is not without reason why Neurology has often been called the Cinderella specialty. This is even more a pity that the studies that have been carried out demonstrate than when a Neurologist is involved in giving opinion in a neurological matter, the diagnosis and/or management will change in 50% of those who are referred. This means that neurological problems can frequently lead to inadequate or wrong care which in turn will lead to potential claims for a breach of duty. Although in the legal world it will be for a general practitioner, general physician or accident and emergency department specialist to give the primary opinion on liability, often the thinking that needs to be applied can be assisted by the early involvement of a Neurologist.

 

Instructions should be sent to my offices c/o The Body Factory Rehabilitation Centre, 105 Nibthwaite Road, Harrow HA1 1TE. My personal assistants Sital and Sonal will be able to help with whatever contact is felt best. I do still prefer hard copy records in order to provide reports and opinion. It is just so difficult to cross reference, particularly in matters of poor care when records are in digital form.