From: Journal of the Association of Clinical Pathologists (ACP News)

Eric Watts review of Clinical Practice and the Law – a legal primer for clinicians:

This is an excellent book and although I approached it with some trepidation, fearing vast expanses of incomprehensible jargon, it is the exact opposite. It is concise at 160 pages and describes all the important concepts with impressive clarity.

Both the legal and medical professions have long histories of their own cultures and a degree of mistrust of each other but what the book makes clear is that there are times when they have to interact. The natural fear that any doctor may have about having their work scrutinised can be reduced simply by adhering to what is generally accepted as good professional standards.

During his years in practice, Giles had extensive experience in conducting and advising in personal injury and clinical negligence claims of all kinds. Giles’ personal injury practice arose from work place and road accidents, as well as claims relating to occupational health issues. This book reflects this wealth of experience, reaching into all medico legal areas with good examples.

The book opens with insights into the legal mind, particularly the use of words, logic and reasoning, and how they really expect to see these in action in medicine as well. It is particularly important to use words clearly, with the precise meaning in context. One example from the clinical field would be to say a patient was “better”, which could either mean improved or completely cured. There is necessarily a great deal on evidence and its various forms, evidence.

It is reassuring to note that a medical opinion is more easily supported when the accompanying facts and reasoning are displayed. The days are gone when the expert, however experienced, can simply say this is Castleman’s disease because I say it is”, the findings that led to the conclusion should be sufficient to show why the conclusion was made. The helpful summary statements such as “Explain decision-making; show your reasoning- throughout the book ensure that the key points make an impact.

The content includes chapters on proof, preparing a witness statement, acting as an expert. records and making notes, and helping the police. Some issues will not be common for pathologists but we need to be aware of them, such as communication with patients, patients in custody, and mental capacity. The important subject of When things go Wrong is very helpful, with the essential principles clearly explained in a manner that reflects real-world experience.

The final statement in his ‘Author’s note’ says: “If you think there is something the next edition should include, let me know – I too am happy to learn.”, showing his commitment to continuous improvement and how we can and should continue to read, discuss, and learn.

Eric Watts

From: Pain News – Two Junior Doctors Review Clinical Practice and the Law

1) This book succinctly sets out the governing principles by which the law interacts with medicine on a daily basis. Everyone, from medical students to consultants, will find it of use.

At 132 pages long, the book focuses on the key areas of clinical and legal practice that cause clinicians the most concern. The chapter on ‘A lawyer’s mind’ provides real insight into how a lawyer approaches medical facts and evidence – something that is not taught in medical school.

Medicine has benefited from borrowing ideas and strategies from other industries, such as patient safety and the aviation industry. Using the more logical legal framework of considering evidence in a stepwise approach, as described and explained by Giles Eyre, will aid in medical diagnosis. It helps clinicians think like lawyers, in a more logical fashion, and may lead not only to more correct diagnoses at the time but also to understanding the thinking behind a clinical case should it be medicolegally re-examined later on.

Inquests/coroners’ courts are words that strike fear into junior doctors’ hearts, and in recent years, as clinical practice comes under greater scrutiny, more junior doctors are being called to give evidence in coroners’ courts. Clinicians may now find themselves working in a litigious environment, with the role of criminal law increasingly finding its way into medicine and having repercussions on how all doctors practise. An example of this is the tragic case of Jack Adcock and Dr Bawa-Garba. GMC and other governing bodies are increasingly scrutinising individuals’ clinical practice and documentation. Note writing and the language we use in clinical records is something else that is not taught in medical school, but such notes are vital and can be scrutinised when things go wrong, or when there is an inquest. The book not only explains clearly the importance of written records and the accurate use of language but contains many tips as to how this may be done effectively and quickly.

An understanding of how cases are looked at ‘from the other side’, and demystifying the process when things go wrong, is very helpful.

As a junior doctor, I found Giles Eyre’s introductory book on the law from a clinical perspective an invaluable adjunct to my clinical practice. This book should be read by everyone who wishes to further their career in medicine.

Laura Munglani BM BCh MRCP

2) A clinician’s first noticeable experience of medical law often, unfortunately, comes at the hands of a complaint, a witness statement or a disciplinary issue leading to trepidation and fear surrounding the subject. However, our day-to-day jobs and actions are often unknowingly based in medical law such as consenting patients for procedures, communicating decisions with patients, assessing capacity or ensuring confidentiality for patient interactions. Retired barrister Giles Eyre successfully aims to share his wisdom gained over many years conducting and advising on medicolegal cases in order to provide clinicians with a thorough grounding in all the aspects of law that a clinician is likely to face throughout their career.

The first chapters clearly define the terms of engagement, taking the reader through evidence, proof and the court system. Eyre spends time explaining how a lawyer’s mind works and uses this as an undercurrent for the subsequent chapters to signpost the importance of documentation, communication, confidentiality and consent. I found this viewpoint particularly enlightening in the author’s elucidation of how a lawyer is likely to interpret the decisions made by clinicians with and without documented explanation of the reasoning behind them. Much as we would ensure that we appropriately note when a patient is able to weigh up their options to interpret their capacity, too often this process is inadequately documented, when instead it is the clinician doing the deliberation. This leads to potential difficulties for a defence lawyer in the event of complaints or serious incidents.

Whilst topics such as confidentiality and consent are taught in medical school the focus is often on the ethical implications rather than the medicolegal. Through chapters on communication, consent, capacity, and confidentiality Eyre gives the reader a comprehensive education in how the law relates to these topics encountered by clinicians daily. His explanations from the perspective of how a lawyer interprets our actions give the reader a more complete insight into both how we can act in the interests of improving patient care through a knowledge of the law and how we ensure that we comply with what is expected of us from a medicolegal standpoint.

Very few, if any, clinicians pursue a career in medicine in order to interact with lawyers. Often this is the antithesis of what we hope our roles involve as doctors. However, at some point in a clinician’s career they are likely to be asked to provide a witness statement – not necessarily because of any wrongdoing but rather as the clinician who provided care to a patient who is themselves, or by cause of injury, then subject to investigation. It is, undoubtedly, a daunting and unsettling task but provided the information written is of sufficient detail and quality, written in the correct way it often mitigates the need for the clinician to give evidence in person. The author provides excellent instruction on the form and content expected by the courts and, on a personal level, having this book would have made the experience of writing my first witness statements for patients seen in the emergency department significantly less daunting.

Although I believe it would be almost impossible to find any clinician (junior or senior) who could not relate to at least a couple of the topics covered throughout the book, this book did feel more aimed at junior clinicians, given its concise and efficient coverage of the basics of medical law. I therefore found the chapter on acting as an expert witness came surprisingly early in the book (although I do understand that it follows “preparing a witness statement”) as I felt it interrupted the continuity of the junior doctor’s otherwise excellent education in the law they are likely to encounter. The chapter itself is, nonetheless, a useful primer and provides aspirational reading for those interested or involved in this more advanced area of medicolegal work. In future editions of the book I feel this chapter would perhaps be a nice addition at the end of the book – a “further reading” point – rather than in the midst of the meaty topics for a junior clinician such as evidence, proof, consent, communication, capacity, confidentiality and documentation.

Overall ‘Clinical practice and the law’ proves to be a valuable resource for any clinician in providing a concise guide to the majority of interactions a doctor is likely to have with the law. It is clearly set out and excellently punctuated with summarising messages for the reader, relevant real-life examples and references from Good Medical Practice and other General Medical Council literature. I would recommend this to any medical student or junior doctor, as well as those more senior looking to revise their knowledge of medical law, and would not be surprised to find this in a medical school core reading list over the years to come. I have already recommended it to a number of colleagues.

Dr Nathan Riddell MBbCh