Wednesday, April 11, 2012

Medico Legal Opinion OBGYN

Journal of Obstetrics and Gyne 2002:24(7):590-2 published the committee opinion of the Council of the Society of Obstetricians and Gynecologists of Canada.  This was excellent work by the committee , with principal authors, Titus Owolabi, MD FRCSC and Dan Farine, MD FRCSC both of Toronto.
First they note that providing expert opinion is a 'grave responsibility' and a 'civic responsibility".  However they make a most important point that an 'expert physician is being as to conduct a peer review and educate those involved in the process of a judicial adversarial adjudication."  The focus of the paper is more specific to OB GYN than generally speaking as it notes that  "Tort or compensatory damage is sometimes demanded by the patient and her lawyer when there has been a bad clinical outcome, on the basis of allegations that appropriate care was not provided.  The quality of the physician's care is often the key issue of the legal action, and consequently the physician is often the primary target of the lawsuit."
There are indeed other reason's for 'medical legal opinion' . This is perhaps the most onerous.  The advise overall remains helpful in this specific sense and in other senses.
In the following discussion about qualifications included an interesting relevancy to training and time "physicians who obtained their relevant qualifications recently to provide opinion on an event that occurred many years ago without declaring this potential discrepancy and without learning the practice patterns and standards of care existing at the time of the event."
I'm of an age now that I really appreciated seeing this.  Young colleagues apparently have no idea what the world was like, sometimes before they were born. They also don't realize that so much that is taken for 'granted' today wasn't 'taken for granted even as little as a decade past.  Science is revolutionary and events like 'cell phone' communications are 'normal' today but I'm from an era of 'radio' and 'wall phone' and just the effect of those technologies on a physicians decisions can't be under estimated. There's tremendous arrogance in the youth and in those who've had the most limitted of practice experience and exposure. Having working in the wilderness, the north, and rural and urban areas I'm routinely aware of the utter ignorance of those in the centre of the reality outside the 'ivory tower'.  The level of stupidity is so profound that it makes it very hard for one to take seriously their pronouncements on matters that because they're microscopic might have some actual relevance.
This paper dealt well with addressing the 'retroscopic perspective'.  Armchair quarterbacks are always so very smug.
The paper gives a good overview of report writing and recommends the physician be clear and even set out what the 'issues' are and then provide an opinion regarding those 'issues'.
The paper further encourages that the physician provide reasons for the basis of the opinion with appropriate reference - "a standard textbook, specific review articles, professional society guidelines, widespread clinical practice in the physicians jurisdiction, or personal experience."
Finally the paper encourages experts to state "opinions that are credible and will stand the scrutiny of peers, leaving advocacy to the lawyers".
This is an excellent paper I would strongly recommend for any physician who has to be an expert in the courts.

1 comment:

mike said...

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