The New Zealand Medical Association recently stated that it believes that “the forensic environment in New Zealand is hostile and a deterrent to good medical practice. The current “blame culture” acts as a deterrent to quality initiatives, early detection and reporting of medical errors. Changes in the medico-legal environment in New Zealand in recent years have occurred with the growth of the Health and Disability Commissioner (HDC), amendments to the Injury, Rehabilitation and Compensation Act 2001 and the Medical Competence Insurance Bill. The importance of these reports should not be underestimated, but their quality is uncertain. Clinical medical practice is supported by the use of evidence-based medicine. The legal system does not have such an instrument. A case review and expert opinion would be considered Level 4 or 5 evidence, not something on which most of us would base or modify our practice. It is important that medico-legal reports are fair to patients, but also to physicians. These reports are the tools lawyers use to crucify surgeons, it requires careful thought and discussion about who should write and what training should be given to those who do. The objectives of these changes are to ensure accountability within the medical profession. New Zealand has one of the highest numbers of lawyers per capita in the world. It is questionable whether the goal is really to increase the work and income of the legal profession. It is useful to include headings and, if the report is long, numbered paragraphs in the report.
As a seasoned assault lawyer, I am very fortunate to be able to not only help injured individuals – help them get their lives in order – but I also have the privilege of training physicians to become competent forensic experts – the physicians who exercise quasi-judicial capacity in a claim for personal injury or clinical negligence. act. Without these brilliant doctors – of all qualifications and specialties – the system would not work. This video will give you basic information on how to write a report and what to expect from the process when asked to be an expert witness. The legal profession can only judge us by the quality of the information provided, if this information is insufficient, it will also be their judgment. A request to an attending physician to prepare a report for legal purposes can be obtained from: Summary: When you are asked to provide a medico-legal report, you usually provide information that can be used in potential prosecutions. We describe the important elements to be taken into account and the practical measures needed to address them. Objective: This article describes the steps to create “good” medico-legal advice, including some of the common pitfalls to avoid. Many surgeons are involved in writing forensic reports on other surgeons.
These reports usually deal with a sentinel event in a surgeon`s office and do not take into account everything that happened before or after. The event will be evaluated on its own. The event is considered independent of resources, fatigue or other problems. The event is a numerator with no denominator, and the greater the practice, the more likely it is to occur. 10.9.1 Be honest and not misleading when writing reports and certificates and only sign those documents you believe to be correct. Over the years, after having hundreds of doctors prepare reports on my injured clients and teach over 100 doctors the basics of a medical law expert, the following 18 points are my best (non-exhaustive) advice for physicians on how to write a good, competent and compliant medico-legal report. There is rarely a legal obligation to prepare a medico-legal opinion, although some legal bodies (e.g. Ahpra, Workcover) may require the preparation of a report in certain prescribed circumstances. Discussion: General practitioners play an important role in preparing medico-legal reports on their patients for a variety of purposes. A medico-legal report can be seen by a diverse, non-medical audience. Once prepared, the report can be used as evidence in legal proceedings and scrutinized.
A structured and comprehensive forensic report can minimize the likelihood of testifying in court. As an emergency practicing physician with a secondary interest in forensic work, I have seen many situations where poor discharge practices can leave physicians vulnerable to complaints and litigation. Background: The preparation and provision of medico-legal advice by the attending physician is an inevitable, but sometimes undesirable, part of general practice. I would make the following suggestions for writing reports. 1. Forensic reports should be prepared by persons practising in clinics. 2. The physician who writes the report must have been in clinical practice for at least 10 years. 3. The physician should have a practice similar to that of the person he or she is reporting.
4. The physician writing the report must be able to provide an experienced “overview” of events. 5. Physicians writing these reports should be trained in legal aspects and understanding the data, as it is very difficult to interpret outcome data. Some of the problems are: a. What is the standard you are commenting on? Should it be a best practice or the accepted minimum standard? b. The person writing the report should be aware that they should not use too much retrospective analysis. Once you know the result, it`s often easy to understand how you got there. In most cases, as we all know, it is possible to improve what we do in one case. Events should be considered with the level of knowledge available to the physician at the time of the event. c.
It is important to understand the data and interpretation of the literature. The importance of this is demonstrated by a paper by Peter Sagar et al 1994 (1), which compared outcomes between two hospitals for patients undergoing colorectal resection. The authors showed that by adjusting for differences between patients, the initial results were reversed. Medical and legal communication are very different. Doctors write for meanings contained in the context they write and are cowardly with simple words. We rely on the context, the sentence and the structure of the paragraphs to create the framework of meaning. Lawyers choose individual words very carefully and care less about fluency and readability. As explained above, a treating physician is not obliged to give an opinion in a medico-legal opinion. In fact, some opinions may go beyond the expertise of the attending physician. In those circumstances, observations should be refused and only factual information should be provided.
Independent medical advice can then be obtained based on the facts and/or medical records provided by the attending physician.