How medico-legal work has enhanced my clinical practice
Here, Iona Collins, a spinal orthopaedic surgeon, reflects on how her work as an expert witness has helped her gain deeper insights into the everyday challenges facing spinal patients and her colleagues in the NHS.
I’m qualified as an orthopaedic surgeon but I’ve only worked in spinal surgery alone since 2007. I got my first consultant job in 2008 and my second in Swansea from 2011 to date.
I started doing expert witness work from around 2016 onwards, focusing solely on spinal issues and instructions pertaining to personal injuries. The clinical negligence requests for assistance have been purely on behalf of the defendants to date, but I have not been described as biased when I have requested feedback.
The Inspire MediLaw training was beneficial to me, providing confidence that I can remain focused on my spinal area of expertise, while being mindful of the tests which will be applied to my evidence.
As my job title indicates, I work as an expert witness outside my NHS work. All the cases involve spinal injuries and, in order to produce a considered opinion, I must read through the person’s GP records (from birth onwards), physiotherapy, hospital and ambulance records and, often, witness statements too. The report usually takes me a week or so in total to process and write up, having also initially met the person for an interview and clinical assessment.
In my NHS job, I never have either the time or volume of information to gain as full an understanding as possible of how a spinal injury affects a person and their family’s lives. I don’t realise how many appointments that person attends, the travelling involved, the intensity of the family involvement and how they change into different people with a smaller world.
In the NHS, the person in front of me will put on a brave face and often underplay their condition, telling me that “they’re struggling a bit” or “if there’s anything you can do to help, I’d appreciate it”. That short NHS appointment will never provide the depth of insight that the medico-legal work provides.
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Thanks to the medico-legal work, though, I am now more likely to ask about suicidal ideation when people present with chronic spinal pain, for example, referring onwards or picking up the phone to secure support, as indicated. I am also more likely to phone people directly with their test results as time allows, instead of unintentionally leaving someone to worry until their next clinic appointment, which can be postponed in the final hour due to NHS system pressures.
Also, though, I sometimes feel completely in awe of my NHS colleagues. When I read the medical records, the bare facts of the situation are laid out in front of me. No emotion – just attention to clinical detail. The ‘written in retrospect’ line demonstrates how staff worked flat out when the patient arrived, to save that person’s life. Once that patient has then moved on to the next step (usually for operations), the staff then write up what they’ve done as a ‘written in retrospect’ account, before carrying on to deal with the next emergency case.
The patient’s family tell me about the speed and co-ordination of the medical teams involved, but the medical notes are quiet by comparison. ‘Hypovolaemic shock’, ‘Trauma series CT’, ‘ett for transfer’ – these are short sentences that say so much.
There is no account anywhere, though, which records how to save that life, or avoid that paralysis, some people somewhere remained on duty for hours beyond their contracted time, or an off-duty team was scrambled from home to open a third theatre. There is no account of how these harrowing experiences impact on the medical staff involved either, especially if system constraints prevent them from doing their best. The work is stressful. The lack of tools, though…
I need this medico-legal work to remind me that I am truly working among heroes.