Dr Graham Howarth has worked at the Medical Protection Society (MPS) for more than ten years,initially as a medicolegal adviser (MLA) and now as Head of Medical Services (Africa). Prior to joining MPS, Dr Howarth had a varied clinical career: after qualifying at the University of Stellenbosch, he went on to qualify as an obstetrician and gynaecologist before completing a Masters in bioethics. Dr Howarth was an Associate Professor in the Department of Obstetrics and Gynaecology at the University of Pretoria and also the founding head of the faculty’s virtual Bioethics Department.
Being an MLA is, in many ways, very similar to clinical practice. I review cases as I would as a doctor; each case has its history, symptoms, diagnosis and, of course, a remedy. Only in my position, the doctors are my patients, and it is with doctors and lawyers that I have most interaction.
You could say that MLAs are the interface between medicine and the law. During my time at MPS I have assisted in a wide range of cases ranging from relatively straight forward advice on minor issues to assisting in the defence of members accused of culpable homicide. The role of a medicolegal adviser is as wide and diverse as our membership.
As Head of Medical Services (Africa), my main priority now is to ensure that MPS delivers the very best service possible to our members and goes above and beyond their expectations.
This means that on a day-to-day basis, my role is incredibly varied. We have a high case load and new cases are constantly opening. I am involved with case-related correspondence and instruct our panel of lawyers on everything from inquests, HPCSA matters, reports and clinical negligence claims.
Case management
Each case is different, but they generally begin by assessing whether or not the doctor involved was a member at the time of the incident, determining whether or not the request falls within the benefits of MPS membership and collating sufficient information needed to make a judgement. Reading the case carefully is the next task, and attention to detail is paramount in order to try and find out exactly what went wrong.
I have found that my previous experience is a real advantage when providing assistance to MPS members as it’s important to be able to understand the clinical detail. Understanding the law is also very important. Lawyers need our medicolegal input, and likewise, we take advice from them. I often video conference with panel lawyers in the major centres to discuss new instructions and problem or interesting cases we have.
Advice and education
Another part of my role is talking to members via our 24-hour advice line. All of the MLAs take it in turns to answer calls. We receive a very wide range of queries, ranging from general questions about consent to disclose medical records, to requests for assistance if a member is called as an expert witness.
I am also actively involved in developing tailored educational material for members. As Editorial Consultant for Casebook, MPS’s medicolegal journal, I contribute ideas for content and provide clinical support and medicolegal advice for case studies and features. I’m also Editor-In-Chief of Practice Matters, a magazine which aims to highlight risks in general practice, and Junior Doctor.
Staying in touch
What I love most about being an MLA is that no two days are ever the same. Coming to work and never knowing what I’m going to be doing on a particular day is demanding and keeps me on my toes, but it’s also incredibly interesting. It keeps me close to the heart of the medical profession in South Africa and abreast of medicolegal issues.
I particularly enjoy meeting our members, stakeholders and panel lawyers, as well as speaking at conferences and events. Presentation opportunities extend from small group meetings where only a handful of members are present through to events such as MPS’s annual Ethics 4 All in Cape Town where I present to over 1000 members.
Being an MLA
Certain personality traits are required to be an MLA. As we deal with various doctors from different backgrounds and you can go from dealing with a paediatrics case one minute to a GP case the next, strong communication skills are essential. Tenacity is important, as is good attention to detail and the ability to accept criticism. Thinking on your feet is a must, as quite often you will be required to make quick decisions.
The current environment
Recently, I have seen that complaints and claims against doctors are increasing in number and value. The law is encroaching more and more into medical practice.
My advice for doctors who may be in trouble is to never run away from or ignore problems, no matter how small or insignificant they seem at the time. All doctors make mistakes. As MLAs, we provide important risk management advice for members, through magazines, factsheets, educational workshops and conferences. We are also just a phone call away to provide advice when doctors have questions or if issues arise.
The most common risk that doctors need to manage is poor communication – both prior to and post an issue occurring. If you thoroughly explain to patients what you are going to do and why, and be open and honest if things do go wrong, you will be less likely to receive a complaint.
At MPS, we strive to make a difference and help our members wherever we can. It is a real privilege not only to assist dedicated professionals to strive to achieve the best possible outcome for the situation that they find themselves in, but also to work with the profession to help create a safer and more secure environment for patients.
Visit page 20 of the August edition of Medical Chronicle to read the article in full >>