I have had rather a varied career. Started doing Medico-Legal in 1990 after joining the Consultant body at the Accident Hospital Birmingham. Inevitable it started slowly and, like everybody starting out I was hardly an expert, but it began with easy cases and gradually built up. I subsequently went on to read Law and then did disability assessments for DWP, obtaining the DDAM. Over 25,000 cases later I think I have probably got there now.
- How did you get into this field of work?
I actually started out by taking over from another surgeon who left and who had been doing a very small amount of this type of work. I got interested, started looking outside the normal work seen in clinics was well that the more routine. It became increasingly obvious that the NHS trauma world and the expert witness world, whilst they certainly had crossovers, were in essence different. The questions were different, the required answers were different and all too often the types of cases were different. The cases that a Consultant would see in clinic were not those that appeared from Solicitors, meaning that just the routine NHS work was wholly insufficient to be an expert in most of the cases that come from solicitors. Although many try it you cannot just walk out of your NHS clinic and suddenly become an expert in something you never see there. People do it and risk their careers every time.
- What does your typical day/week look like?
My week effectively starts in the Office on Tuesday, where every set of notes received I the previous week is completed and all cases for the coming week are given and initial examination. This gives me the chance to contact Solicitors if I see any problems or missing records that they may not have been aware of. After that clinics used to be Wednesday, Thursday, catching up on Friday and another clinic on Monday. Then COVID. I did about 500 cases on WhatsApp, most of which went perfectly well, and with the advantage that distance was irrelevant – my most long distance being Panama City, where the only place he could get a signal was Macdonalds. I am now finding that when lock down was in place, nobody went out an injured themselves in shops, at work or on the road; cases are significantly down.
- What is the most interesting matter that you have worked on?
I have a few obsessions. My main one, just because of sheer volume, is the diagnosis of soft tissue Thoracic outlet Syndrome in cervical spine and upper limb injury cases. I can hear the chorus of ‘that doesn’t exist’ from here. Well, just go to the Mayo clinic website, type in TOS and you will find they think it does, top of their list of causes, so I am with them and have been for 30 years. In case of a whiplash mechanism (NOT whiplash injury, please and rear-end impacts only; other directions are different), I would reckon it is about 80%, less so for non-whiplash mechanism RTA, and less again for shoulder injuries. Claimants very rarely volunteer symptoms although some may give vague neurological symptoms, which I often see recorded in a report and then entirely ignored. There are a lot of these cases. Anyone, at any level, who does not acknowledge and look for this condition is not an expert in these conditions.
My other hobby horse is disability. Most experts have no qualification or experience in disability assessment. Medico-legal work is all about disability and matching claimed symptoms to recorded or claimed disability. If it does not add up then something fishy is going on. If the expert does not add it up, they are not an expert.
- What are the highs and lows of the job?
Highs, always getting the correct medical report for the claimant/ defendant especially if something has previously been overlooked and a case that appeared not to add up can be made to do so.
Lows often relate to colleague’s behaviour or solicitor behaviour. About ten times a year I get reports from dinosaur defence experts. Their reports breach Part 35 (which I am certain none of these people have read). What is depressing is that they are allowed to get away with it. For my worse example see Barrister Magazine ‘Nightmare at St Aldgates’, where an expert, in a different field to the case in hand (it was an occupational health case in which he had no experience or qualification ), was allowed to give a totally made up version of events without a single piece of corroborative evidence and was preferred by the Court – incompetence at the highest level, both medically and legally.
Solicitor behaviour centres on asking for alterations to a report to increase the values of the claim without presenting any evidence. I refer them to LVI vs Khan and others and politely refuse, but having to do this at least once a week gets wearing.
- What advice would you give to someone wanting to start out?
It was some years after I started before formal training came into being, and even later when it became more widespread. I would now consider it obligatory; but where to start? Begin with a report writing course, such as those offered by Bond Solon. And do so before taking on any cases. You will need to formulate a pre-printed template to fill out on every case. It saves time, ensures nothing is left out and speeds the process because the questions are all the same, the answers differ.
Take on a few cases of injuries that you see on a daily basis. Do not be tempted into the RTA/ Cervical spine injury world unless you really know what you are doing, They are numerous and look easy but they are far more complex than they first appear, and are very frequently incorrectly assessed. In general only GPs will see significant numbers of them and then only for analgesia and sick notes.
As soon as you feel able, go for the full Cardiff University/ Bond Solon course (also known as CUEW) as this also prepares you for court room skills (needed in about one in every thousand reports but essential). Above all read and understand the CPR part 35 and practice directions. You sign a declaration at the end of the report that you have read and understood them, make certain it is true. Never stray outside your area of expertise, however small that is.
Mr R Scott-Watson
BSc(Hons) MB BS LLB (Hons)(Open)Cert. Av. Med. Cert.MR(2)CUEW DDAM FRCS(Ed)
Orthopaedic Surgeon, Expert Witness & Disability Analyst APIL Expert
Medico-Legal Reporting since 1990. Over 24,000 reports.