Working as a medicolegal adviser

Medicolegal advisers are the interface between doctors and the legal process, handling a wide variety of cases ranging from general advice through to claims, complaints, regulatory issues, inquests, and criminal investigations. In project managing cases, we liaise with the doctors concerned, instruct solicitors and barristers as necessary, and oversee the overall running of the case.

I have been a medicolegal adviser at the Medical Protection Society since 2006. Before that, I was a consultant in anaesthesia and intensive care. I moved in response to a growing fascination with how the complexities of law and ethics applied to my clinical practice as a consultant, initially qualifying as a barrister before starting work at the Medical Protection Society.

As clinicians we are familiar with the responsibility of holding the lives of patients in our hands; as medicolegal advisers it is the careers of doctors that are in the balance. Depending on the course a case takes, that may also mean every aspect of a doctor’s life and wellbeing.

The comparisons with clinical practice illustrate some characteristics that make this role so fascinating and engrossing: the doctor is now in the patient’s chair, seeking expert advice from the medicolegal adviser, who is back in the consulting room. Each case has its history, symptoms, diagnosis, and, of course, a remedy.

A lot rests on how well the medicolegal adviser handles the case. The role is emotionally and intellectually demanding and requires high levels of stamina. A sense of humour is also invaluable—in the right place and at the right time.

The job itself is varied and there is no typical day. A medicolegal adviser can be office based one moment, and the next moment travelling across the country to attend meetings, represent doctors at disciplinary hearings, or lecture, meeting a wide range of people across primary and secondary care.

Medicolegal advisers create a team to support, represent, and assist doctors. Not surprisingly, doctors find the process of any type of investigation extremely difficult, so we listen to their concerns, help them to understand the situation they find themselves in, and support them throughout. As project managers we have to be highly organised, and we must be patient and empathic while retaining the objectivity necessary to offer what we believe is the best advice.

Fundamentally, we are advisers. It is not our role to give clinical advice, but medicolegal advisers do have a major role in improving standards across the medical profession. We are advocates for patient safety and risk management and are uniquely placed to understand the pitfalls that can lead to legal, regulatory, or disciplinary problems.

We are increasingly presented with situations where poor continuity of care has contributed to an adverse outcome. Working environments involving shifts and reliance on locums, for example, threaten continuity of care. Good communication is crucial—with patients, between colleagues, and in all written documentation. The colleague taking over cannot read your mind; nor can the lawyer defending you when there are no records to support your version of events.

In recent years I have seen for myself that complaints and claims against doctors are increasing in number and that the value of compensation being sought is rising. There is no single reason why the number of complaints and claims has risen, but there is certainly a greater awareness of medicine among patients and greater expectations of the profession.

There is also greater encouragement for patients to report complaints as a result of a number of high profile inquiries in recent years, and patients are not the only ones raising concerns. Doctors have a non-delegable professional obligation to promote and protect patient safety. This includes a professional duty to act on potential risks to patients. An increasing awareness of this duty means that some of our workload relates to complaints or investigatory processes that have been initiated by another healthcare professional.

I loved my long career in medicine, but I can honestly say that being a medicolegal adviser is the best job I have ever had. 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.

As a medicolegal adviser I know I am making a difference. The satisfaction is, in truth, immeasurable, and not something easily put into words.