Whether you take on the role of medical officer at a pop concert or expert witness in a trial, you need to be prepared, says Dr Gerard Panting of the MPS
The opportunities for general practitioners to work outside their NHS general medical duties are numerous and varied.
Medical officers are always in demand for sporting events and concerts, and for those who prefer to remain surgery based, insurance and employment medicals offer extra income, as does occupational health work. Doctors fascinated by the law and crime may find forensic medical examiner work or providing expert opinions in personal injury cases more to their liking, while those of an academic bent may prefer involvement in clinical research projects.
However, there is no such thing as a free lunch, and extra income derived from any extension of normal practice is usually hard earned.
The golden rules
When taking on any of these extracurricular responsibilities, the golden rules are to ensure that:
- Whatever you have been asked to do falls within your expertise
- You are clear about your professional responsibilities – this is especially important when acting on behalf of a third party
- You have all the necessary facilities and support required to complete the task to a reasonable standard.
Sporting events and concerts
If you are asked to attend a sporting event because the organisers would like to have a doctor on site, your responsibilities, paid or not, extend beyond just turning up on the day safe in the knowledge that your usual out of hours bag is in the boot of your car.
Before deciding whether or not to accept the invitation, it is essential to understand exactly what sort of event it is and what medical emergencies you might be expected to face.The test here is not what you are likely to be confronted with but what is reasonably foreseeable, including, where there are spectators, injuries in the crowd.
The next question to consider is whether dealing with these conditions is within your expertise. You also need to decide what equipment, facilities and assistance you would require and what evacuation arrangements need to be in place if someone needs to be admitted to hospital.
If you are satisfied on all these counts, you should next check that you have appropriate indemnity in place. The GMCÍs requirement is set out in Good Medical Practice: ïIn your own interests, and those of your patients, you must obtain adequate insurance or professional indemnity cover for any part of your practice not covered by an employerÍs indemnity scheme.Í1
Do not assume that you will be covered by your normal GP subscription, as some medical defence organisations do not provide indemnity for sporting events as an integral part of GP membership, particularly where professional sportspeople are involved.
Concerts may appear to be an easier option but claims do follow from these events as the following case history demonstrates:
A reveller at a pop festival tripped on a tent peg and gashed her leg. She was seen by a doctor in the medical tent who irrigated the wound and sutured it. About 36 hours later, she reported that her leg was sore and antibiotics were prescribed, but following her return home, the wound broke open. At her local A & E department, further debris was removed from the wound. She is left with an unsightly scar.
The case was settled for £3700 taking into account the poor cosmetic result and the additional pain and suffering caused by the infection which was the result of failing to remove debris from the wound.
Employment and insurance medicals
Employment and insurance medicals can be conducted on your own premises and require only readily available equipment. However, conducting an examination for a third party is different from examining and treating a patient. Here the doctor is acting as an independent medical examiner providing objective information and perhaps an opinion on the examinee to the commissioning company. This has implications for obtaining consent.
The GMC guidance on consent in these circumstances contains the following:
ïPatients can indicate their informed consent either orally or in writing. In some cases, the nature of the risks to which the patient might be exposed make it important that a written record is available of the patientÍs consent and other wishes in relation to the proposed investigation and treatment. This helps to ensure later understanding between you, the patient, and anyone else involved in carrying out the procedure or providing care. Except in an emergency, where the patient has capacity to give consent, you should obtain written consent in cases where: …
- Providing clinical care is not the primary purpose of the investigation or examination;
- There may be significant consequences for the patientÍs employment, social or personal life;
- The treatment is part of a research programme.Í 2
In addition, if you are, or have been, responsible for the care of the patient, the Access to Medical Records Act 1988 applies.Where the company decides that a medical report is necessary, it is the companyÍs responsibility to obtain consent and notify the examinee of his or her rights under the Act.
Once a report has been produced, patients have 21 days to exercise their rights of access and then consent to dispatching the report or to request amendments or append statements to the report.
Even where no access is required at the time the report is prepared, patients have a right to seek access after the report has been dispatched.
Forensic medical examiners
The role of the forensic medical examiner may be two-fold.The first is to provide medical care to individuals in custody and the second is to collect evidence from both victims and alleged perpetrators of crime.
When treating detainees as patients, the fact that the setting is a police cell is incidental. In the main, the normal duty of care exists, as does the duty of professional confidence, unless there is a conflict with professional interest.
When acting as an independent forensic assessor Æ obtaining and recording evidence on behalf of the police Æ the relationship is entirely different. Consequently, it is imperative to ensure that the detainee or alleged victim fully understands the doctorÍs role and responsibility and that written consent is obtained to any examination or collection of samples.
Where the doctor is expected to perform both roles simultaneously the situation is more complex. In these circumstances, it is essential to distinguish the roles and ensure that the appropriate form of consent has been obtained to each element of the consultation.
Being a medical expert in legal cases may appear to be a glamorous option, but the grass may not seem quite so green when you are actually standing on it.
Experts are required in all sorts of cases, from road traffic accidents to clinical negligence cases and criminal prosecutions.The key to success lies in painstaking objective analysis, sometimes by reference to available evidence in the literature. Once you have embarked upon a particular case, it is very difficult to extract yourself from it and court dates will take priority over any personal arrangements you have made.
The emphasis the new civil procedures rules place on expediting proceedings means that there is now a greater expectation that expert witnesses must arrange their affairs to meet the commitment of the court.
In a recent Court of Appeal ruling, although the court recognised that medical practitioners often have other demands on their time, ïit was essential that it was appreciated that whereas the courts would take account of the important commitments of medical men, they could not always meet those commitments in a way which would be satisfactory from the doctorÍs point of viewÍ.3
If parties want hearings to be held on dates that suit them, the arrangements must be made as early as possible through cooperation with each other and the court. If the court fixes a date for a hearing when an expert witness cannot attend, he or she must give the reason why they are unavailable.
In addition, experts are not above criticism. In particular, unsubstantiated opinions and partiality may result in criticism from the judge or, in more extreme cases, investigation by the General Medical Council with all the publicity that will inevitably attract.
- General Medical Council. Good Medical Practice. London: General Medical Council, May 2001.
- General Medical Council. Seeking patientsÍ consent: the ethical considerations. London: General Medical Council, November 1998.
- The Times Law Report, Matthews v Tarmac Bricks and Tiles Ltd, 1 July 1999.