Image © Mikhail Konoplev
Medico-Legal Magazine’s issue number 5, featured lawyer Andrew Gray of Truth Legal providing some timely advice to medical consultants in his article entitled ‘Claimant Interview Tips for Medical Experts’. Doctors providing medical reports and for better or worse, often enjoying little contact with their instructing solicitors beyond in-direct correspondence, will have valued his advice. But they’ll also have a number of points they would like to convey to those solicitors who ask for their opinions. If only there was a better forum in which experts and solicitors could meet occasionally on an informal basis to exchange their views. Perhaps one day that will come, but in the meantime, perhaps I can offer a few thoughts to the legal profession that crop up regularly in the course of my own many years of medico-legal practice.
1. Direct instructions or via an agency?
Once upon a time, solicitors had their favourite experts and sent instructions directly. Directories such as that created by SpecialistInfo are designed to help this process. Now, to the mystification of many experts, instructions frequently come via intermediary agencies. Some of these agencies are excellent, but some less so. When lay desk staff is interposed between solicitors and medical professionals, communication is bound to suffer, and to be prolonged through extra steps. Clearly, solicitors must see administrative advantages to seeking their experts through an agency. But from the other side, doctors see inevitable misunderstandings when, for example, a list of questions is submitted in response to a report and comes via the agency. Who do we reply to? The terms of the agencies mostly prohibit direct communication with the solicitor, and yet the act of picking up the phone to a solicitor for clarification can be invaluable.
2. Medical records
It’s surprising how many times these are incomplete. For example the hospital treatment record is sent but the emergency department notes are missing. Or the records from GP, hospital and other treatment centres arrive in dribs and drabs. Or the relevant report of a former expert is missing. It would not be beyond a combined panel of doctors and lawyers to produce a simple universal checklist which could avoid these situations.
And when we do get all the records, there’s another hurdle . . . . digitisation! In theory, this should help by removing the need to transfer vast bundles of paper notes. In practice the situation is not always better. Experienced doctors instinctively find their way quickly around paper treatment records. But when those records have been randomly scanned by a filing clerk, sometimes sideways to the left, to the right or even upside down, the situation becomes a nightmare to assess on-screen. Often it takes more rather than less valuable time to examine such records. Instructing solicitors need to understand that. And if we’re going paperless, to ensure we receive the passwords that are frequently missing!
3. X-rays
Old x-ray records are mostly sent on disc and this is a big plus in terms of more compact information. But it is surprising how many different digital systems there are in UK hospitals alone. Each requires its own set of instructions to allow access and very commonly these are not clearly explained. That can easily involve another 15 minutes of head-scratching for the expert. And when, during or following the medico-legal consultation, we need a fresh x-ray, there is frequently a delay produced because of the necessity to obtain permission. Whilst its perfectly understandable that cost control is important, sometimes access to the solicitor by phone would result in a swift pragmatic decision. Worst of all is when an immediate decision is not forthcoming because of the need to go through an intermediary agency and the poor claimant has to be sent away, perhaps many miles, to return another day.
4. Patient ID
Because of instances of impersonation, it’s understandable that solicitors and agencies are more and more asking doctors to confirm that the claimant in front of them is the one who really is the solicitor’s client. But it’s surprising the number of times the claimant, when asked for passport or driving licence, simply replies “I was never told to bring it!”
5. Requests for alteration of a report
A touchy subject amongst experts! Yes, of course, if we’ve missed something or expressed something poorly then most experts are only too happy to make an appropriate correction prior to service. But if a claimant goes home, and decides he/she has forgotten to tell us something despite a comprehensive interview, then it’s hardly fair to ask us to review our report, make alterations, re-type, review and re-despatch at zero cost. And most contentious of all, when a claimant or solicitor reads the report and decides that an expert’s opinion given in good faith doesn’t do their case any good, is when the request comes for an alteration. We usually get sent copies of CPR 35 reminding us that our obligations are to the court and so it’s embarrassing and frustrating to be put in this position. As I’ve already pointed out above, this can be the ideal time for an expert to have ease of access to pick up the phone and have a few friendly words with the solicitor. But it isn’t that easy when there’s an intermediary agency. And that’s when heels tend to get dug in.
6. Fee payments
On the whole, not a problem, although as an expert, I do occasionally wonder if solicitors forget that doctors also need to feed their families. Or so it seems when invoices can take many months to settle. Yes, we can all set our terms and conditions, but most doctors seriously dislike chasing fellow professionals for bills for which, of course, we’ll be taxed on via the invoice, irrespective of whether settlement has arrived. Even more do we dislike asking for payment for reports up front, which sometimes becomes necessary after defaults.
Over the years, I’ve enjoyed the happy relationships I’ve had with good lawyers in the course of responding to instructions for expert reports. As in all walks of life, its ease of communication which avoids almost all problems and which usually makes medico-legal work a professional pleasure. Let’s talk!
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