Which Medico Legal Expert?
By Mr. Ameen Abbas Ameen, Consultant Neurosurgeon
I write on this topic because of the confusion I came across in my 23 years of medicolegal report writing with many solicitors often not knowing the appropriate specialty of the medicolegal expert to send their cases to.
This is not surprising as many medical specialties quite often overlap between themselves when it comes to patient treatment and often even between a medical speciality and a surgical one.
In clinical practice medical specialities overlap as well, patients are often treated by more than one specialist for the same clinical problem, the examples are many such as prolapsed lumbar intervertebral discs treated by Neurosurgeon and the pain Specialist. Neurosurgery as an example is closely related to Neurology rather than to another surgical specialty hence our weekly clinical meetings to discuss difficult cases is with Neurologist not with another surgical speciality.
Spinal Injuries
These commonly arise following car accidents, or injuries at work.
Spinal injuries with clear evidence of injury to the spinal-cord or the nerve roots manifested as neurological deficit in the form of muscle weakness or paralysis are usually treated by Neurosurgeons specially those who have sub specialised in spinal problems and call themselves “Spinal Neurosurgeon”.
In the current days of sub specialisation, nearly all neurosurgical units have now adopted the practice of dividing themselves into either cranial or spinal Neurosurgeons let alone the division of the cranial neurosurgeons into many subspecialties such as skull base, vascular, functional neurosurgery, oncological neurosurgery etc.
To add to the confusion of the Solicitors, many orthopaedic surgeons have also chosen to be a spinal surgeon as well, it is a clearly not advisable to refer Medico-Legal cases with the spinal problems to the occasional neurosurgeon or the occasional orthopaedic surgeon who have only treated sporadic cases of spinal injuries every now and then in their current or past clinical practice hence the importance of reviewing the CV of the medico legal expert before any referral.
The recent sub specialisation has brought with it the advantage of building a good experience and knowledge in dealing with specific clinical problems but with a disadvantage of losing the expertise and the updates with other clinical problems in their own speciality, such as emergency cases referred to the hospital either during normal working hours or later on when they are on call.
Clinical Negligence Matters
When it comes to clinical negligence it is certainly more important to refer such cases to the expert who has developed particular expertise and interest in that specific clinical problem the client developed after his injury or died from and preferably experts with long and extensive experience especially if the alleged negligence happened many years ago when the clinical practice was probably different from what is the practiced nowadays.
Neurologist, Neurosurgeon or Psychiatrist?
Specific clinical neurological problems such as Multiple Sclerosis or motor neuron disease are clearly best referred to the neurologist while head injuries should be referred to the neurosurgeon as they are the one who treat them as emergency cases in clinical practice. However many post traumatic head injuries symptoms are treated either by the neuropsychologist or the epilepsy specialist after being discharged from further care and follow up by their Neurosurgeon.
I am afraid that the dream of the Solicitors to cut the cost of the expert’s fee by asking one expert to deal with all aspects of post traumatic head injuries sequalae is not practical and cannot be achieved as in clinical practice very often many specialists are practically involved in treating the residual symptoms following head injuries and which are quite often long-lasting and difficult to treat.
About the Author:
Mr. Ameen Abbas Ameen, LMSSA, FRCS (Neurosurgery) is a Consultant Neurosurgeon with 38 years’ experience in Hospital Neurosurgery and over 22 years of Medico-Legal reports writing in UK. His main interests are in Head and Spinal injuries including Whiplash, Stroke, Brain tumours, Degenerative Cervical and Lumbar spine disease, Cauda Equina and Negligence Claims.
His current turnaround for medico-legal reports is approx 2-4 weeks. His instruction ratio is: Claimant 70% Defendant 20% and 10% as a Joint Expert and he attends Court 3-4 times /year.
Mr Ameen can be contacted for all medico-legal work and to request his CV at ameenameen@inneg.co.uk
