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Should medicolegal medicine be part of the medical school curriculum?
  1. John W Norris1,
  2. Colin J Mumford2
  1. 1Department of Clinical Neurosciences, St George's Medical School, London, UK
  2. 2Department of Clinical Neurosciences, Western General Hospital, Edinburgh, UK
  1. Correspondence to Professor John W Norris, Department of Clinical Neurosciences, St George's Medical School, London SW17 0RE, UK; carotid{at}btopenworld.com

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Introduction

Physicians, in general, know nothing about the law when they qualify, and lawyers rarely ever know anything about medicine as it relates to the law. The two professions are uneasy bedfellows, yet not infrequently meet in settings favourable to lawyers but not to physicians. This is especially true in law courts, where physicians may be intimidated by unfamiliar and often grandiose surroundings, such as the Royal Courts of Justice in London (figure 1). Moreover, there is an increasing tendency for dissatisfied patients to launch legal actions against doctors, sometimes encouraged to do so by ‘ambulance chasing’ firms of lawyers, and supported financially by questionable allocation of legal aid funding. This may apply especially to neurology, where inevitable diagnostic uncertainty and frequent lack of effective treatments, may be interpreted as inadequate, or substandard care by anxious patients and their relatives.

Figure 1

The formal environment of a courtroom may be daunting.

The nature of the problem

Increasing litigation does not necessarily indicate falling standards, but claims to the National Health Service (NHS) litigation authority in England and Wales rose from 5426 in 2006 to 8665 in 2010, an increase of 60% in just 4 years, and undoubtedly are still rising. Healthcare consumed just 4.6% of the UK's Gross Domestic Product in 1950 compared to nearly 10% in 2009.1 Within that budget, the NHS Litigation Authority (NHSLA) consumed a staggering proportion: as of 31 March 2014 the NHSLA estimated its potential liabilities at £26.1 billion, of which £25.7 billion related to clinical negligence claims.2 So despite increasing expenditure, have standards of care fallen? Have public expectations risen? Or could there be a new awareness of a ‘pot of gold at the end of the rainbow’ for lawyers as well as for patients who litigate against their medical practitioners? There are now new and effective drugs available for many …

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    Phil Smith Geraint N Fuller