The medical expert: it could be you

Medical expert opinion is crucial in criminal, civil, coronial and GMC processes. It can determine whether or not a case, an investigation or in the worst scenario a conviction for gross negligence manslaughter (GNM) is pursued or closed. In the family courts, medical opinion is relied upon in relation to decisions where the lives and wellbeing of children are at stake.

Medical expert opinion is undoubtedly important for all involved as it can lead to changes that improve patient safety and ensure a just outcome. However, it can also lead to a doctor losing their career. 

It is therefore vital that a large and diverse range of doctors make themselves available to provide medical expert opinion. Sadly, however, this is not the case and this is why Medical Protection has launched an ongoing campaign to encourage more doctors to take on this work, and to reduce the barriers that stop them from doing so.

Medical Protection are not the first to raise this problem. Three reviews in the past decade have highlighted the issues around the recruitment of experts. The report of the Working Group on Experts in the Family Courts highlights that there is currently a lack of appropriately qualified doctors willing to undertake expert work. This leads to delays in the judicial process, with potentially harmful consequences for children and families. Instruction of an expert often relies on word of mouth, and there is no central register. The Williams Review into Gross Negligence Manslaughter in Healthcare  highlights similar concerns, as does Leslie Hamilton’s 2019 Independent Review of Gross Negligence Manslaughter and Culpable Homicide. Both these reviews called for improvements in the training of medical experts, and support for those wishing to undertake the work. 

Both the Williams and the Hamilton reviews recommended that experts should be in current, relevant, clinical practice. Ongoing involvement in clinical work helps to ensure that experts are up to date; it also allows for a more realistic assessment of what is ‘reasonable’, as opposed to ‘textbook’, or ‘gold standard’ practice. This is because those working within a system are best placed to understand its challenges and imperfections. Such understanding is crucial as systems issues often play a key role when things go wrong in medicine; they inevitably impact on the care provided by a doctor, so they deserve consideration within an expert report. 

Our recent report looked at the role of the medical expert and stated that it should be mandatory for expert reports to include consideration of any system issues that may have played a role in an adverse patient outcome. Medical Protection has also called on the GMC to set this out in the next iteration of Good Medical Practice. Taking this broad focus, rather than simply scrutinising the actions of an individual in isolation, can improve patient safety and reduce the medicolegal risk faced by doctors. 

It could be argued that the majority of consultants and GPs, particularly after an initial period in post, should have the requisite technical knowledge to provide an expert opinion in their field of practice. However, very few come forward to do the work. While barriers are varied and complex, they include financial considerations, lack of training and support, and fear of criticism.  

It is also difficult to combine the demands of the court with those of a busy clinical practice. Experts describe how hard it can be to persuade employers to allow them to take time out to perform their duties. But employers should recognise the gains associated with supporting employees to participate in expert work. By doing so, they will be building up a resource of skill and experience that can be tapped into as required; for example, those who undertake expert work will be well-placed to conduct SI investigations and root cause analyses and share learning with colleagues. Allowing doctors to diversify their skill sets and role may also improve job satisfaction and staff retention and prevent burnout. 

The Medical Protection report makes clear that NHS employers, NHS England, the GMC and the Academy of Medical Royal Colleges all have a role to play in bringing about positive change in this area. But we as doctors also need to step up. Doctors should consider putting themselves forward to provide expert opinion if they have relevant experience; ideally, while being in current clinical practice. All doctors who have achieved a Certificate of Completion of Training and who are on the appropriate register should possess the clinical knowledge to act as an expert within their field, and should feel empowered to do so.