Finding good doctors to provide impartial expert medical opinions for clinical negligence cases is a huge challenge for the medico-legal sector. There simply aren’t enough well-qualified doctors taking on expert witness work.
Medical expert opinion can influence the whole outcome of a clinical negligence case so it’s vital that more doctors come forward to take on this work. And there’s a need for younger doctors to get involved, as well as older practitioners.
In our latest blog, Dr Adrian Rees, GP and expert witness, reflects on his experiences of working in medico-legal practice and shares his advice on getting started in this role.
I’m a GP based in Leeds and I’ve taken on expert witness work alongside my clinical commitments for the past eight years. I’m also an honorary lecturer at the University of Leeds Medical School, and a GP trainer.
I first became interested in medico-legal work when I gave evidence as a witness of fact in a GMC tribunal. As a trainee doctor in A&E, I also saw my hospital involved in a legal case so this really sparked my interest.
After several years in general practice, I completed a Master’s Degree in Medical Ethics and Law and then set up my own medico-legal practice.
A forensic eye for detail
I work on both clinical negligence and personal injury cases. My role is to provide an independent medical opinion on a case, drawing on the medical records, witness statements and other documents.
The litigation process involves several stages – writing up the report, taking part in conferences with counsel (with the legal team) and also participating in ‘meetings with experts’ with the doctor on the other side. On occasion, the case will progress to court and I’ll be called to give evidence and cross-examined on my opinion. The case can settle at any stage in this process.
As an expert witness, you need a forensic eye to review a patient’s medical records in a clear, methodical and objective way. As a doctor, your role is to bring clarity to grey areas of medicine for interpretation by the legal profession.
Being able to explain complex medical details in a simple form is also an important skill.
Working on my first case
Before I got started, I completed some medico-legal training, which is crucial if you’re planning to take on expert witness work.
Working on my first case was really interesting, enabling me to put into practice the skills I’d learned during the training. I simply applied those skills – reading the letter of instruction carefully, making sure I grasped what was required and thoroughly reviewing the medical records and other case documents. It’s also vital to keep an eye out for a smoking gun that might determine the whole case.
Being cross-examined in court
It’s worth noting that few clinical negligence cases go to court; most settle before that stage. But I have given evidence in court for both clinical negligence and personal injury cases.
In a strange way, I always enjoy the experience of giving evidence in court. The stakes are high, and you’ve got to be ‘on your game’. The key is to make sure you’ve prepared thoroughly.
Good presentation and communication skills are also very important – and ensuring you’ve answered the questions fully and accurately. That’s why court training can be so helpful.
It’s an interesting experience being cross-examined – although I wouldn’t want to go to court every day!
The best kind of CPD
Working as a medical expert witness provides a very rare opportunity to review someone’s entire medical history. Generally, you just don’t get this opportunity in a clinical setting as there simply isn’t enough time.
Some doctors worry about medico-legal work being adversarial. But it’s very stimulating to have your opinion challenged. You bring all that knowledge back to clinical practice, which makes you a better doctor – it’s the best kind of CPD you can get. Medico-legal work has also helped me become a better teacher in my work at the University of Leeds Medical School.
Balancing my commitments
You need good time management skills to balance your clinical commitments and medico-legal work. I spend two days a week in general practice and three days on medico-legal cases – and I’m usually booked weeks in advance for medico-legal work. I have to be well-organised and flexible to deal with any urgent requests that come in.
I focus mainly on clinical negligence cases nowadays. On average, I complete around two medico-legal reports each week – around 120 reports a year. I receive several requests for my medico-legal services each week.
Getting my practice off the ground
Setting up your own practice is straightforward. I decided to operate through a limited company – which was very easy to set up. I also arranged professional indemnity insurance and got up to speed on all the GDPR regulations.
There are also practical aspects to consider when you’re starting out – I work from a co-working space for part of the working week but I also have a home office. You need somewhere quiet, with safe storage for any letters or other documents.
You also need to decide whether you’re going to manage your own diary and admin or outsource this to a secretary or virtual assistant. I find it easier to manage my own diary and I run the whole business on Google Workspace – which is very cost-effective.
Finding my first clients
Marketing is key when you’re getting started. All you need is one instruction, and it tends to snowball from there.
At the start, I cold-called clinical negligence solicitors, which resulted in three or four instructions. I also sent my medico-legal CV to clinical negligence lawyers, set up a simple website, via GoDaddy, and presented at conferences. My first conference presentation resulted in several new instructions. It’s important to be responsive and follow up on any leads.
I’ve also always offered free initial opinions on potential cases. So, a solicitor will contact you and ask whether there is merit in taking a claim forward. This helps to build a relationship with the solicitor, often leading to a full instruction if the case proceeds to litigation.
Initially, I took on quite a lot of personal injury (PI) work, including whiplash claims. PI reports don’t require the same level of analysis as clinical negligence reports. It’s a good way of building your knowledge and getting to know solicitors before moving on to higher-value clinical negligence cases.
Why we need more doctors to come forward
I know that some doctors worry about criticising other medics in expert witness work. But your role is to provide an independent opinion to help the legal professional understand the medicine and advise on what constitutes a reasonable standard of care. Your job is not to make the decision about whether a doctor has been negligent. That’s for the courts to decide.
So, if you’re looking for a new challenge that offers great pay, I would highly recommend expert witness work. We definitely need more good doctors to come forward. Expert witnesses have a vital role to play in providing quality control to the medical profession. This roots out poor practice, and it improves the quality and reputation of the medical profession.
If you’re interested in finding out more, talk with others already working in this area to get a better understanding of what’s involved. You should also complete some medico-legal training so it’s worth contacting Inspire MediLaw, which runs dedicated training for medical professionals. I’m also happy to chat with any doctors who want to learn more.