Articles

Lead Article – May 2022 Repetition It is both fascinating and infuriating that little seems to change in the medicolegal sphere. There have been some major advances over the last decade or two with PIPA and the CLA but in … Read More

Case Vignette – May 2022 Do X-rays Lie? With traumatic lesions, there is an old saying that the situation can “never be better than the worst x-ray”. There is much truth in this axiom. It means that if you can … Read More

General Advice – May 2022 How to Succeed with a Negligence Claim Don’t expect to read about any tricks. There are none. Instead, careful scrutiny of all of the records and radiographs, separation of complications from under-performance, a careful analysis … Read More

Lead Article – April 2022 No Wonder Plaintiffs Are Confused I recently examined a patient with a sore back. He had a congenital (from birth) pars defect at L5 and a spondylolisthesis of L5 on the sacrum. In simple language, … Read More

Case Vignette – April 2022 How Much Is An Injury Really Worth? I recall a youngish woman (33 years of age) who was bumped by a horse and fell gracefully onto soft lawn. The entire event was witnessed by many … Read More

General Advice – April 2022 Why Do Orthopaedic Surgeons Do It? Orthopaedic Surgeons who proffer advice through medicolegal reports are usually motivated by at least two stimuli.   The first is a genuine interest in matters of both medical and … Read More

Lead Article – March 2022 Mandatory Reporting I recently attended a dinner hosted by, and for, members of both the legal and medical professions in Queensland. There were three speakers dealing with the topic of mandatory reporting and all came … Read More

Case Vignette – March 2022 I Sometimes Change My Mind Prior to seeing a patient for a personal injury claim, I read the available documentation. This includes hospital and medical notes, recordings from the general practitioner and importantly, specialty notes … Read More

General Advice – March 2022 Please Pay Your Bills Medical negligence cases typically involve reams and reams (or megabytes and megabytes) of material to decipher, digest and analyse carefully. It takes many hours.   Some solicitors, typically those acting for … Read More

Lead Article – February 2022 What’s the Difference Between the Heart and the Brain? From the medical perspective, there are very significant differences between these two important organs. I won’t bore you with them.   From the legal perspective, the … Read More

Case Vignette – February 2022 The Features Some Plaintiffs Suffer I saw a fellow recently who had been working in western Queensland as a helicopter musterer for about 11 years. He had obviously started early because he was only 30 … Read More

General Advice – February 2022 The Plight of the WorkCover Patient I rarely perform IME’s for WorkCover, but regularly see plaintiffs being sent along for a second opinion after having received an unpleasant WorkCover settlement offer.   Whilst the principal … Read More

Lead Article – December 2021 Beware the Recidivist Claimant Very few of us will ever lodge a civil claim for personal injury in our lifetime. A small proportion of us will have one claim and possibly two, although that would … Read More

Case Vignette – December 2021 It’s All a Matter of Scale I recently saw a young man who sustained an injury in the region of his cervical spine whilst playing touch football at an Army base in 2015. It appears … Read More

General Advice – December 2021 Fair Enough I understand that lawyers often take sides in matters. In fact, firms declare themselves as being either pro-claimant or pro-defendant. They wear it as a badge of honour. I sometimes try to put … Read More

Lead Article – November 2021 Personality Does Matter Over the last two months, I have seen two plaintiffs alleging medical negligence against a so-called “first surgeon”. Both patients had undergone total hip replacements by different surgeons. Let’s call them surgeon … Read More

Case Vignette – November 2021 Beware of Some Chiropodists There have been recent reports in “The Australian” newspaper about a patient who had undergone some form of “body modification” procedure by an unqualified practitioner. As I understand, a silastic compound … Read More

General Advice – November 2021 Some Things Never Change I have had an undying interest in medicolegal reporting for four decades. There have been some changes over that period and in particular, the Court processes do appear to have been streamlined. … Read More

Lead Article – October 2021 Who’s in Charge of Medicolegal Report Quality Control? I really don’t know! Medical graduates in Australia are subject to registration requirements imposed by the Medical Board of Australia and its administrative arm, the Australian Health … Read More

Case Vignette – October 2021 Sexual Boundary Violations I know, this is a very unusual topic for an Orthopaedic Surgeon to be exploring. The Notifications Committees of the Medical Board of Australia not infrequently deal with complaints of inappropriate behaviour … Read More

General Advice – October 2021 Qualities You Should Look for in an Expert Since I have spoken about the need for some form of quality control with medicolegal reports, it is also appropriate that I list some of the qualities … Read More

Lead Article – September 2021 Orthopaedic Injuries Can Make You Mad I am using the word “mad” quite loosely.  I am not suggesting that the orthopaedic injury will give rise to psychiatric or mental illness but instead, can be irritating, … Read More

Case Vignette – September 2021 Can You See the Funny Side? Whilst my sympathy for injured individuals is genuine and maintained, I can also sometimes see an element of humour.  At the risk of causing offence, I keep my mirth … Read More

General Advice – September 2021 Try Not to Pre-empt the Consultation Plaintiffs presenting for medicolegal examinations will have various expectations.  Some think that the whole process may take several hours.  Others will believe that the examiner will hurt them (either … Read More

Lead Article – August 2021 You Can’t Be Serious! You will all recall this famous phrase, commonly attributed to John McEnroe. Whilst I would never publicly condone poor sportsmanship, especially in the public arena, I did derive great pleasure from … Read More

Case Vignette – August 2021 Horses are Heavy A 28-year-old secretary was visiting a local winery on a Sunday afternoon. By all accounts, she enjoyed herself enormously. The food was excellent, the wine flowed copiously and although she was able … Read More

General Advice – August 2021 You Get What You Pay For I have touched on this subject before. I recently received a request to perform a medicolegal examination (dealing with alleged medical negligence) by a medical defence organisation. Accompanying the … Read More

Lead Article – July 2021 “Over a Period of Time” Injuries It is timely that we revisit this particular topic. Claims are becoming more frequent, the cases are more complex and the outcomes are even less certain. Causation is so … Read More

Case Vignette – July 2021 Osteoporosis of Pregnancy Osteoporosis refers to demineralisation of the collagen structure in bone. It presents clinically as fractures caused by minimal force and radiographically by bones that are far less radio-dense than normal. Whilst the … Read More

General Advice – July 2021 Patient Demeanour All of us are subject to bias. Even the most revered of judges in the Supreme Court will have some preconceptions based upon past experiences in life.  Orthopaedic surgeons are no different. Patients … Read More

Lead Article – June 2021 What Would We Do Without MRI Scans? We may well be better off! I say that with only partial flippancy. MRI scan examinations obviously do add considerably to the ancillary investigative regimen that can assist … Read More

Case Vignette – June 2021 Scaphoid Fractures – Litigation Fodder There are numerous small bones that form the wrist joint. They are divided into proximal and distal rows, with one of the bones partially crossing the divide. This is the … Read More

General Advice – June 2021 Preparing Your Client for a Medicolegal Examination Plaintiffs presenting for medicolegal examinations are quite often struggling. They have been subjected to an initial insult or injury, have required a therapeutic programme or regimen that could … Read More

Lead Article – May 2021 How Unlucky Can You Be? I recently performed a medicolegal examination at the request of a solicitor acting on behalf of WorkCover. The plaintiff, a gentleman who had been involved in a motor vehicle accident … Read More

Case Vignette – May 2021 How Hard Do You Look? I am referring specifically to past medical history. I recently saw a plaintiff who was thought to have sustained a knee joint injury “over a period of time” as a … Read More

General Advice – May 2021 Will It Ever Stop? This personal injury industry is a bit like a self-saucing pudding. It never seems to diminish. In countries where there is “no fault” insurance (for example, New Zealand), this type of … Read More

Lead Article – April 2021 Are X-rays Really Necessary? Yes. It is hardly likely that I would pose this question for it to be responded in the negative! It is important for legal colleagues to understand that the diagnostic and … Read More

Case Vignette – April 2021 The Wrong Pathology I usually draw upon cases that I have seen to structure this section of The Medicolegal Mind newsletter. On this occasion, I am sourcing a dream I had recently. I was with … Read More

General Advice – April 2021 The Wrong Direction I am seeing an increasing number of cases of alleged negligence. I suspect that is because I am older, have a special interest in the area and am prepared to call it … Read More

Lead Article – March 2021 Same Injury – Two Outcomes Consider two 20 year old men. They were unfortunately involved in identical accidents on the same day; each injuring his right knee. John was a third year electrical engineering student … Read More

Case Vignette – March 2021 Implant Breakage Total hip replacements have been performed in one form or another for about a century. By comparison with current standards, the early implants were quite naïve and often failed rather quickly. Professor Sir … Read More

General Advice – March 2021 Is It Worth the Effort? Some aggrieved patients are keen to pursue a perceived under-performing Orthopaedic Surgeon for damages after an adverse event. The anger, frustration and disenchantment all fuel that desire. Some of them … Read More

Lead Article – February 2021 Who Should Take the Rap? An elderly lady was unfortunate enough to fall in a shopping centre. She sustained a fracture involving one of her hips and some associated bruising and lacerations involving her face. … Read More

Case Vignette – February 2021 My Mate with the Medial Meniscal Tear A mate of mine was playing touch football recently and sustained a bucket handle tear involving his medial meniscus. He is in his late forties but is otherwise … Read More

General Advice – February 2021 How Can I Best Boost My Medicolegal Claim? I was approached recently and asked for advice about how a patient could best prepare for a medicolegal claim. The patient had been involved in a road … Read More

Lead Article – January 2021 Shifting Sands The rate of evolution of orthopaedic surgery is extraordinary. Whereas 30 years ago, teenagers or patients in their early twenties would spend six weeks or more in traction following a femoral shaft fracture, … Read More

Case Vignette – January 2021 The Metal-on-Metal Debacle Hip replacements usually involve a metal or ceramic ball articulating with a plastic, ceramic or metal cup, or acetabular component. Articulations between metal/ceramic and plastic or polyethylene usually perform very well and … Read More

General Advice – January 2021 Can the Court System be Trusted? I assume that most lawyers would say “yes”. They have been schooled in the system, belong to the club and have a vested interest. Doctors, not uncommonly, have a … Read More

Lead Article – December 2020 Two in One Week— I have been involved in two medical negligence cases in the last week. They were strikingly similar although from different states, involving patients of different gender and regarding different parts of … Read More

Case Vignette – December 2020 When I was a Young Fella When I was a year 12 high school student, I was involved in a motor cycle accident. It happened during the course of the year 12 examinations and I … Read More

General Advice – December 2020 Whilst We’re on the Topic of Medical Negligence No win, no fee lawyers can have great difficulty in deciding whether or not a plaintiff’s case is meritorious. The difficulty arises because significant costs can be … Read More

LEAD ARTICLE – November 2020 New Concepts in the Medicolegal Business Arena For the last 30 or 40 years, we have seen sole operators acting as experts, producing reports and defending their positions in the personal injury and medical negligence … Read More

CASE VIGNETTE – November 20020 The Confounding Effects of Time I am referring specifically to younger patients (those who have not yet reached skeletal maturity) who might be subjected to a constellation of quite severe injuries of a widespread nature. … Read More

GENERAL ADVICE – November 2020 Subspecialty Crossover I recently consulted with a patient who had sustained a combination of injuries involving an upper limb. There was an element of crushing, along with electrical burns. The management team included a trauma … Read More

LEAD ARTICLE –  OCTOBER 2020 Dealing with the Belligerent Plaintiff I am genuinely sympathetic towards Plaintiffs who are obliged to present for medicolegal assessments. With rare exceptions, all have been injured. They believe that the injury has not been their … Read More

CASE VIGNETTE – OCTOBER 2020 Who’s Responsible? Tony is a 30 year old diesel fitter. He jumped from the rear of a Caterpillar dozer and landed awkwardly some 90cm below on uneven terrain. He sustained a twisting injury to his … Read More

GENERAL ADVICE – OCTOBER 2020 Do Injuries “Occur Over a Period of Time”? Yes and no! Injuries occurring “over a period of time” are not of a single type, variety or format. Some injuries are at the minor end of … Read More

LEAD ARTICLE –  SEPTEMBER 2020 Reality Bites I enjoy a life outside medicolegal reporting. It is a blend of agribusiness and hospitality, and I regularly engage with members of the public. Many are quite discerning. I recently entertained a couple … Read More

CASE VIGNETTE – SEPTEMBER 2020 The Erosive Effects of Time I recently reported on an individual who had sustained a significant lumbar spinal injury over a decade ago. Eight years ago, he was subjected to an operative discectomy that was … Read More

GENERAL ADVICE – SEPTEMBER 2020 Choosing Your Expert This has become a relatively common theme in this newsletter. The revisitations simply emphasise the importance of the matter. By way of analogy, I sometimes see general practitioners referring their patients to surgeons … Read More

LEAD ARTICLE –  AUGUST 2020 Reputation Stick with me here. It will display relevance at the end. Let’s talk about Individual A and his reputation. The word “reputation” is frequently used or engaged in assessing a person’s performance, personality or … Read More

CASE VIGNETTE – AUGUST 2020 Bad Luck or Negligence? Pedro was a 73 year old immigrant who had previously been quite active. He played tennis, walked regularly and also rode his bike. He recalled injuring his right hip joint whilst … Read More

GENERAL ADVICE – AUGUST 2020 Medical Negligence Assessments Litigants are becoming increasingly aware of the existence of medical negligence, and the potential for appropriate compensation. Orthopaedic Surgeons are not unique in this area and despite the best of intentions, negligent … Read More

LEAD ARTICLE – JULY 2020 Conduct Money – How Far Will $30 Stretch? Whilst subpoenas can be an efficient way of ensuring that witnesses appear in Court, they are generally discouraged by experts and are usually not required. Instead, there … Read More

CASE VIGNETTE – JULY 2020 How Valuable are Photographs of the Accident Site in Assessing Injuries Sustained? They are relatively useful. I use that adjective “relatively” advisedly. I understand that extremes can occur. For example, some passengers may escape unscathed … Read More

GENERAL ADVICE – JULY 2020 Are MRI Scan Examinations Overused? Yes! MRI scan examinations are expensive, useful predominantly for soft tissue injuries and should be used as an adjunct to a thorough clinical examination. Until a few years ago, only … Read More

LEAD ARTICLE – JUNE 2020 When Experts Differ This has been a recurring theme over the last 30 issues or so and is worthy of revisitation. Differences between experts are not necessarily unusual and neither should they be unexpected. After … Read More

CASE VIGNETTE – JUNE 2020 Wrong Site Surgery I wonder how many of you have heard of the condition “Morton’s neuroma”? A neuroma is a swelling on a nerve. Morton first described a swelling involving the confluence of two digital … Read More

GENERAL ADVICE – JUNE 2020 Egos, Empires and Orthopaedic Surgeons There are many facets to a medicolegal practice that give me great pleasure. I genuinely enjoy meeting the plaintiffs. I derive pleasure from the intellectual challenge that is often posed. … Read More

LEAD ARTICLE – MAY 2020 When 10 + 10 = 19 Seriously? Yes, I am serious. It is when the American Medical Association publication entitled “Guides to the Evaluation of Permanent Impairment”, 5th Edition (AMA 5) is used to assess … Read More

CASE VIGNETTE – MAY 2020 Growth Plate Injuries and Their Importance The long bones in our skeleton grow longitudinally. There are so-called growth plates at either end of the bone separating that part of the bone that forms a joint … Read More

GENERAL ADVICE – MAY 2020 Radiographic Imaging – Hard Copy Films or Digital Representations? There has been great momentum in the radiology sphere to recording radiographically obtained images in a digital format. The reasons are obvious. Costs can be curbed, … Read More

LEAD ARTICLE – APRIL 2020 Downturns Can Mean Upturns Every journalistic piece – printed, visual or auditory – has focussed upon the contagion COVID-19 for the last six weeks or so. Most of the talk is black. A few brave … Read More

CASE VIGNETTE – APRIL 2020 Fracture/Dislocations of Joints Can be Exceedingly Challenging Consider the case of the society matron (only 61 years of age) who sustained a fracture/dislocation of her dominant thumb. The joint involved was between the first metacarpal … Read More

GENERAL ADVICE – APRIL 2020 Should Medicolegal Consultations Continue During the Lockdown? There is no unbreakable rule on the matter, although a case can be made for continuance. Factors include the consultation room still being a workplace, plaintiffs are often … Read More

LEAD ARTICLE – MARCH 2020 Medicolegal Report Invoices – When Should They Be Paid? There is no hard or fast rule on this matter and I understand that commercial pressures will push and pull in different directions. The “no win, … Read More

CASE VIGNETTE – MARCH 2020 Past History Is So Very Important I recall seeing a patient who was injured in a road traffic accident whilst descending the Toowoomba Range on a very powerful Harley Davidson motor cycle. It is likely … Read More

GENERAL ADVICE – MARCH 2020 What Happens To Your Client During A Medicolegal Examination? It is all very well for you to send your injured Plaintiff off to an Orthopaedic Surgeon for an independent examination and report. The appointment is … Read More

LEAD ARTICLE – FEBRUARY 2020 How Important is Empathy? Vital! Orthopaedic Surgeons are sometimes criticised for being harsh, aggressive and lacking in soft emotions. Unfortunately, some of that criticism is true. Personalities are usually moulded and set well before Orthopaedic … Read More

CASE VIGNETTE – FEBRUARY 2020 Indolent Infection  Following Serious Orthopaedic Injuries Bacterial infections continue to give rise to significant difficulties with orthopaedic surgery, whether it be in the emergency setting or at the time of elective operations. The pivotal work … Read More

GENERAL ADVICE – FEBRUARY 2020 Is There a Need to Standardise Personal Injury Regulations Throughout Australia? Possibly. Although Australia covers an enormous surface area and distances between our cities are similar to those in the United States of America, our … Read More

LEAD ARTICLE – JANUARY 2020 Why Do Doctors Fear Litigation? I am not referring to the role some doctors assume as expert witnesses. That can be stressful, although experience and emotional disengagement usually dissipate the anxiety. Instead, I am referring … Read More

CASE VIGNETTE – JANUARY 2020 Non Sequitur is a Real Phenomenon It can often be accepted that an accident occurred. In addition, an injured party may exhibit significant impairment and loss. What is not always so clear is the presence … Read More

GENERAL ADVICE – JANUARY 2020 Talk, Talk, Talk I understand that there is no property in a witness, that expert witnesses are to be objective and non-partisan and that the cut and thrust of adversarial law should be excluded from … Read More

LEAD ARTICLE – DECEMBER 2019 Christmas Greetings – What Do They Mean? Our Christmas celebrations have started already and the big day is only a week or so away. Despite the shopping crowds not being as frenetic as usual, parking … Read More

CASE VIGNETTE – DECEMBER 2019 Even Santa Claus is Vulnerable Folklore has it that Santa became stuck in the chimney of an old house in East Brisbane in December 2017. There was no particular obstruction in the chimney flue itself … Read More

GENERAL ADVICE – DECEMBER 2019 When Experts Differ Although orthopaedic surgeons are usually trained approximately equally, use the same reference texts and examine the same plaintiff contemporaneously, reports can differ wildly. This can be frustrating for legal representatives and may … Read More

LEAD ARTICLE – NOVEMBER 2019 Are Conclaves Valuable? I am referring to the Court-directed meeting of experts to rationalise differing opinions and create a unified approach where possible. Obviously, I am not talking about the meeting of Cardinals just prior … Read More

GENERAL ADVICE – NOVEMBER 2019 Are Surveillance Videos Worth their Salt? As the economy bites deeper, as more spurious claims appear and as insurers become wiser, so do I see a greater number of surveillance videos forming part of the … Read More

CASE VIGNETTE – NOVEMBER 2019 Military Service and Tribunal Claims When attempting to link orthopaedic pathological conditions with previous military service, the issue of causation can be particularly vexing. All too often, the nexus is quite nebulous. For example, a … Read More

CASE VIGNETTE – OCTOBER 2019 Not All Prior Injuries Remain Relevant Gary is a 38 year old male, heavily tattooed and with five children to two partners. His eldest son is 18 years of age and has never had a … Read More

GENERAL ADVICE – OCTOBER 2019 How Can We Share Knowledge? Continuing Professional Development (CPD) is both vital for our performance and mandatory for our registration. The basic principle is the acquisition of knowledge and the ability to use it wisely. … Read More

LEAD ARTICLE – OCTOBER 2019 When Pain is a Pain Pain is the predominant symptom in 95% or more of orthopaedic conditions. Patients rarely complain of deformity, functional loss, malalignment or disability. The presenting complaint is almost always pain. The … Read More

LEAD ARTICLE – SEPTEMBER 2019 How Much Explanation is Too Much? The AMA (5) Guides are both prescriptive and proscriptive. Table 17.2 is a perfect example. When assessing a lower limb impairment, there is a serious risk of measuring the … Read More

GENERAL ADVICE – SEPTEMBER 2019 Is Your Expert an Expert? It can be very difficult to know. You could reasonably expect that a specialist holding qualifications from one of the Specialty Colleges would conform. Unfortunately, that is not always the … Read More

CASE VIGNETTE – SEPTEMBER 2019 Complex Injuries in Complex Patients Let’s consider Wendy. She is a 45 year old Papua New Guinean who was born with phocomelia affecting her left upper limb. The major arm bone, the humerus, was congenitally … Read More

CASE VIGNETTE – AUGUST 2019 Lovers’ Heels How many of you have heard of this injury – Lover’s Heels? In simplest terms, it refers to fractures of one or both of the calcanei or heel bones. It is classically sustained … Read More

LEAD ARTICLE – AUGUST 2019 How Much Is A Pro Bono Service Worth? Well, it depends upon which side of the fence you sit. If you are the provider of the pro bono service, there is obviously no financial gain (at … Read More

GENERAL ADVICE – AUGUST 2019 Certification and Recertification The American Board of Independent Medical Examiners (ABIME) is combining with the Australian Orthopaedic Association (AOA) and the Royal Australasian College of Surgeons (RACS) in conducting training and refresher courses for medicolegal … Read More

GENERAL ADVICE – JULY 2019 Is Your Expert Qualified? I have written previously on the topic of experts straying beyond their field of expertise. There is the Neurosurgeon who is sometimes found to comment upon shoulder injuries. Occupational Physicians stray … Read More

LEAD ARTICLE – JULY 2019 When Is Apportionment Appropriate? The issue I am addressing is whether or not the clinical condition displayed by a Plaintiff following an injury is due in its entirety to the injury. Stated differently, “not all … Read More

CASE VIGNETTE – JULY 2019 Not Everything Is As It Seems Orthopaedic surgeons rely heavily upon radiographs to diagnose fractures. Fractures in themselves can be sub-classified in a myriad of ways. In essence however, a fracture refers to a discontinuity … Read More

GENERAL ADVICE – JUNE 2019 Why Would You Use A Broker? I use the term “broker” in a specific way. I am referring to companies dealing in the personal injury arena and acting as intermediaries between lawyers and expert reporters. … Read More

CASE VIGNETTE – JUNE 2019 More Than One Way To Skin A Cat I recently saw a patient who had a long spiral fracture of his femur or thigh bone. It had been managed operatively with the insertion of a … Read More

LEAD ARTICLE – JUNE 2019 Is Your Doctor WorkCover Friendly? Loaded question obviously! Friendship is a very useful facility and one to be encouraged in our society. It permeates social, recreational and professional liaisons. It does not necessarily spell conflict … Read More

CASE VIGNETTE – MAY 2019 The Issue Of Causation – Direct And Indirect I recently saw a chap who sustained an exceedingly severe compound fracture dislocation of his ankle. In fact, his foot was almost ripped off. The photographs that … Read More

LEAD ARTICLE – MAY 2019 Most Experts Are Not Expert In Everything This is a relatively common theme, and one upon which I have previously touched. It is generally accepted that specialists should stick to their own specialties. In fact, … Read More

GENERAL ADVICE – May 2019 The Opioid Epidemic The last decade has seen a dramatic increase in the supply and use of naturally occurring and synthetic opioids. These mind-altering drugs are usually prescribed as powerful analgesics. The implication there is … Read More

LEAD ARTICLE – APRIL 2019 Talking To Patients Or Clients Lawyers and doctors have this capacity and duty in common. We have to converse at the outset, during the course of some form of liaison and at the time of … Read More

CASE VIGNETTE – APRIL 2019 An Evening At The Broncos Try to imagine a winter’s afternoon, a Friday, at about 5:30pm. I was sitting in my consulting rooms on Wickham Terrace with my back to the window. The window gave … Read More

GENERAL ADVICE – April 2019 Educating The Experts I have written previously on how lawyers should educate their experts on the types of reports they need, the questions that should be answered, the issues that should be avoided and the … Read More

LEAD ARTICLE – MARCH 2019 New Kids On The Block I find both national and international politics fascinating. Not that I’ve ever been tempted to put my toe in that murky water but trends, persuasions and emerging difficulties can be … Read More

CASE VIGNETTES – MARCH 2019 Temporal Links Are Not Always Important I saw a chap this morning. He is 72 years of age and gave a history of having fallen from a tram in Melbourne in July last year. The … Read More

GENERAL ADVICE – MARCH 2019 Complaints To AHPRA And The Medical Board Of Australia I recently received notification from the Office of the Health Ombudsman in Queensland that I had been the subject of a compliant. The complainant had been … Read More

LEAD ARTICLE – FEBRUARY 2019 CLINICAL EXAMINATIONS AND SEXUAL BOUNDARIES Whilst clinical examinations form a vital part of any orthopaedic assessment of a patient’s malady, examinations of an intimate nature are very rarely required. The definition of an intimate examination … Read More

GENERAL ADVICE – FEBRUARY 2019 Staying Calm Under Enemy Fire Whilst Orthopaedic Surgeons are usually comfortable within the operating theatre environment, that same equilibrium does not extend to the Court room. Delivering evidence in chief is usually straightforward. The cross-examination phase … Read More

CASE VIGNETTES – FEBRUARY 2019 Who Would You Get To Do Your Hip Replacement? Lawyers typically know which fellow practitioners are good and those who are not. Whether the need is for a commercial litigator, a mediator, a criminal lawyer … Read More

GENERAL ADVICE – JANUARY 2019 DOES A SECOND JOINT SUFFER BY FAVOURING A FIRST JOINT? I regularly see patients who have an injured hip, knee, elbow or shoulder who subsequently complain of an injury involving the contralateral joint (the same … Read More

CASE VIGNETTE – JANUARY 2019 PRE-EXISTENT ABNORMALITIES CAN BE MADE WORSE A 25 year old male cyclist was dislodged from his bike whilst riding out towards the Brisbane Airport. He landed awkwardly and sustained a dislocation of his right patella. … Read More

LEAD ARTICLE – JANUARY 2019 SAME WORDS BUT VERY DIFFERENT CONNOTATIONS I recently saw a middle-aged male patient who had fallen from a height of some 900mm (about 3’) from the bottom step of a dump truck at a coal … Read More

LEAD ARTICLE – DECEMBER 2018 Trick or Treat? You may have read an article last month in a state-wide newspaper concerning “claim farming”. Some of the figures quoted were rather alarming – for instance, a figure of $75 per year … Read More

GENERAL ADVICE – DECEMBER 2018 TIPS FOR CONVERSATIONS, WHETHER THEY ARE VERBAL OR WRITTEN Members of an audience will be struck by the dramatic difference in modes of delivery between legal practitioners and medical practitioners. Whilst there will always be … Read More

CASE VIGNETTE – DECEMBER 2018 ASSESSING SPINAL INJURIES USING THE AMA 5 GUIDES Chapter 15 of the AMA 5 Guides explains specifically that whenever possible, the Diagnosis Related Estimate method should be employed. For example, if there is a fracture … Read More

GENERAL ADVICE – NOVEMBER 2018 Medical Negligence – The Most Bitter Pill Of All I suppose less than 10% of my medicolegal practice deals specifically with issues of medical negligence. That ratio is predicated by the frequency of medical misadventure … Read More

CASE VIGNETTE – NOVEMBER 2018 Farm Accidents II have harboured a long-held passion for all affairs of an agricultural nature. My interests extend to cattle, sand mining, sandstone quarrying and also viticulture. When I was a lad, I had a … Read More

LEAD ARTICLE – NOVEMBER 2018 What Does The Future Hold? The personal injury and medical negligence scenes have been evolving slowly but inexorably over the last three or four decades. Whereas the liaison between the medical and legal professions was … Read More

GENERAL ADVICE – OCTOBER 2018 Dealing With The Administrative Appeals Tribunal Far be it for me to lecture a Lawyer on how to deal with the AAT. That is not my brief. Instead, I intend to share some thoughts about … Read More

CASE VIGNETTE – OCTOBER 2018 A Case From 1979 I clearly remember being an Orthopaedic Registrar at the Royal Brisbane Hospital in 1979.  I was still an unaccredited Trainee, hoping to enter the esteemed echelons of the Orthopaedic Training Programme … Read More

LEAD ARTICLE – OCTOBER 2018 Horses for Courses Whilst I am reluctant to revisit issues, there are some that are so important that reiteration is valuable. When choosing the expert for the opinion you require for the purpose of litigation, … Read More

LEAD ARTICLE – SEPTEMBER 2018 Keeping It Simple I can imagine that litigation is complex enough. Having an expert further cloud the waters must border on the intolerable. Even though some plaintiffs experience a constellation of complex, almost overwhelming injuries, … Read More

CASE VIGNETTE – SEPTEMBER 2018 When There Is Nothing To Be Found, Is It Possible That Nothing Has Happened? Although plaintiffs can almost always clearly explain an event, it is sometimes more difficult to relate that description to the claimed … Read More

GENERAL ADVICE – SEPTEMBER 2018 Can You Change The Expert’s Mind? I am referring to the scenario where an expert’s report does not align closely with the complaints made by the plaintiff or with your own perception of the plaintiff’s … Read More

CASE VIGNETTE – AUGUST 2018 A Simple Stumble – A Lifetime Of Misery I recently saw a 45 year old male who sustained a knee injury whilst leaving work one afternoon.  The injury occurred in winter of 2015.  It was … Read More

GENERAL ADVICE – AUGUST 2018 When To Appeal A WorkCover Tribunal Decision WorkCover usually requests a so-called Independent Medical Examination (IME) prior to forwarding a claim to the Tribunal for determination and prior to settling a claim. There has been … Read More

READER FEEDBACK – AUGUST 2018 This is the 17th edition of “The Medicolegal Mind” and since it is being issued monthly, we have been going for that many months. The number of subscribers has grown steadily and it is heartening … Read More

CASE VIGNETTE – JULY 2018 Are MRI Scan Examinations Important? Sometimes! There is no substitute for the taking of a full history and the performance of a thorough physical examination. A good Orthopaedic Surgeon can usually make a diagnosis in … Read More

GENERAL ADVICE – JULY 2018 Should a Solicitor Accompany a Plaintiff to a Medicolegal Examination? Well, in reality, that’s up to you. I estimate that I have performed about 12,000 medicolegal examinations over the last three decades or so.  During … Read More

LEAD ARTICLE – JULY 2018 Can Lower Limb Surgeons Comment Upon All Orthopaedic Matters? In general terms, yes. Orthopaedic Surgeons in Australia, with Australasian qualifications from our College, undergo an exceedingly rigorous programme before Fellowship is conferred. All facets of … Read More

GENERAL ADVICE – JUNE 2018 Too Soon, Too Far I am referring to the question of when it is appropriate to have your plaintiff examined for medicolegal purposes.  When does the patient reach Maximal Medical Improvement?  When is the condition … Read More

LEAD ARTICLE – JUNE 2018 The Future Economic Loss Paradigm Is Changing Most personal injury claims have a significant component costed for future economic loss.  Injured plaintiffs are typically absent from the workplace for weeks or months and more often … Read More

CASE VIGNETTE – JUNE 2018 The Scars Were All On The Inside Catherine was a 45 year old mother of three young children, happily married and working in a full-time capacity as a primary school teacher in a provincial centre … Read More

  CASE VIGNETTE – MAY 2018 Who Fractured My Femur? My heart went out to this 78 year old lady. She had undergone a total hip replacement about six years previously. It was never much good from the start. She … Read More

GENERAL ADVICE – MAY 2018 We Get What We Pay For! I am a commercial animal. I understand a balance sheet, see a need to reconcile revenue with expenditure and generally make a profit. I also understand the need to … Read More

  LEAD ARTICLE – MAY 2018 How Do You Give Plaintiffs Bad News? Whilst this lead article is directed principally at lawyers acting for plaintiffs, it will also be of some assistance to defendant lawyers. I am referring to the … Read More

GENERAL ADVICE Where Does Medicolegal Experience Come From?   The answer is pretty obvious.  From all sorts of places, really.   From the medical perspective, competence is directly proportional to experience.  That is not to say that the two equal … Read More

Case Vignette Multiple Injuries In The Lumbar Spine The AMA 5 Guides recommend that expert reporters quantifying impairments use the so-called “Diagnosis Related Estimate Category” method for assessment.  There are several reasons for that recommendation.  One relates to the potential … Read More

LEAD ARTICLE – APRIL 2018 How Useful Are Past Medical Records?   I usually answer “vital” but there are some obvious exceptions.   When assessing a functional loss or quantifying an impairment, and attributing that loss or a component of … Read More

Case Vignette Hand Injuries Can Be Difficult To Assess Next to the brain and the eye, I regard the hand as being one of the most complex anatomical structures that humans possess.  The precise placement of bones and the astonishing … Read More

Lead Article How Complex Can Complex Matters Get? It is obviously a rhetorical question. How deep is the ocean, how long is a piece of string, when will the car journey as a child every end? Causation is a case … Read More

GENERAL ADVICE  Which Cases Should You Take On? Obviously, this will vary according to your persuasion – whether you are acting for the plaintiff or the defendant. From a plaintiff’s perspective, there are a few simple steps that should be … Read More

Case Vignette Some Foot In The foot is made of three components.  There is the hindfoot with the calcaneus and the talus (the ankle bone), the midfoot with the tarsals and the bases of the metatarsals, and the forefoot with … Read More

Case Vignette Some Foot Injuries Are More Severe Than They First Appear The foot is made of three components.  There is the hindfoot with the calcaneus and the talus (the ankle bone), the midfoot with the tarsals and the bases … Read More

Lead Article Interesting Cases As I look back over 30 years of medicolegal reporting, I estimate that I have produced more than 10,000 reports.  In fact, this is a fairly conservative estimate and I am confident the number is significantly … Read More

General Advice Advise The Plaintiff What To Expect This is obviously easier for lawyers acting for the plaintiff.  There is a direct dialogue which precedes the referral to the medicolegal reporter.  It is more difficult for the defendant lawyer or … Read More

General Advice Which Documents Should You Forward To Your Medicolegal Expert Reporter? I have touched on this issue in a previous newsletter.  In essence, send everything.  That may mean there will be some extraneous material through which the expert reporter … Read More

Case Vignette Do All Shoulder Injuries Require Surgical Intervention? No.     Many patients over the age of 40 years already have some intrinsic degenerative change within the soft tissue restraining structures around the shoulder joints.  Those restraining structures are … Read More

Lead Article Where is the Personal Injury Industry Headed? Good question, you might agree.  There is anecdotal evidence that the number of claims has reduced somewhat over the last three or four years and this could mirror a gradual improvement … Read More

Lead Article Should Medicolegal Reports Be Solicited From a Treating Orthopaedic Surgeon I am referring here to the provision of a report for the Court by an orthopaedic surgeon who has been intimately involved in the management of injuries sustained … Read More

General Advice Do X-rays Lie? The problem does not lie with the x-rays.  Instead, the potential problem is with the viewer of the x-rays.  I am referring to the reporter, the expert who is interpreting the films.   There is … Read More

Case Vignette Scarring And Other Things Patients suffering personal injuries sometimes sustain lacerations resulting in scars.  Others require operative intervention which also results in some scarring.  Scars will vary in their severity, extent and cosmetic importance.  Chapter 8 in the … Read More

General Advice Who Should Provide Medicolegal Reports? Experts. That sounds like a glib response to the question but it does contain some truth. It is a Special Calling Medicolegal reporting is a subspecialty in its own right. For many years … Read More

Case Vignette Overreaction And Inconsistency Not all patients are ridgy-didge. Not all patients are as badly affected as they have you believe. Not all presentations can be explained in purely orthopaedic terms. That is to say, some patients overreact, behave … Read More

  Lead Article Plaintiffs’ Docs and Defendants’ Docs – Do They Exist? Yes, I am afraid they do. In fact, you all know who they are. I can think of one or two colleagues who really are “bleeding hearts”. They … Read More

Case Vignette Multi-level Lumbar Spinal Injuries   Lumbar spinal maladies are best assessed using Chapter 15 in the American Medical Association publication entitled “Guides to the Evaluation of Permanent Impairment” (5th Edition).  Other tomes can also be used should the … Read More

General Advice Derogatory Reports The best medicolegal reports are those that are devoid of emotion. Clear, non-polarised, objective reports stand on their own. Unfortunately, some expert reporters deviate from the midline and allow themselves to engage in less desirable activities. … Read More

Lead Article Dealing With The Difficult Plaintiff A medicolegal consultation with an injured, aggrieved plaintiff can be a very testing time for all involved.  It can involve a heady mix of emotions including anger, resentment, frustration and fear. It would … Read More

General Advice Differentiating Between Complications And Negligence Negligence is a term used by lawyers and not necessarily in the purview of medical practitioners. From a medical practitioner’s perspective, the term relates to three interlinked activities.  The first is the presence … Read More

Case Vignette Knee Ligament Injuries The knee joint is a most complex structure.  It is capable of hinging, gliding and rotation.  Attempts to reproduce this complex biomechanical event have been met with limited success.  Nature’s competence includes a special arrangement … Read More

Lead Article Can Future Care Costs Be Significant? Yes!  They can become enormous.  Consider for example a previously, fit, well and active 20 year old female who has been rendered quadriplegic in a jet ski accident on the Broadwater in … Read More

Lead Article Future Therapeutic Costs – Who Pays What and When? Plaintiffs undergoing a medicolegal examination have usually reached a state of Maximal Medical Improvement (MMI) following the index injury or incident. Many months and sometimes years have elapsed and … Read More

Case Vignette Is It The Shoulder Joint Or The Acromioclavicular Joint? The shoulder joint is formed by the upper end of the arm bone (the humerus) and a socket (the glenoid) on the outer edge of the shoulder blade (the … Read More

General Advice Mandatory Reporting In The Medicolegal Setting The national law governing health practitioners in Australia contains a subsection dealing specifically with mandatory reporting. This is where practitioners who are aware of some significant underperformance on the part of a … Read More

Case Vignettes But He Didn’t Hurt His Ankle! The plaintiff sustained a fracture involving the upper end of his shin bone.  It was managed successfully, it had united without difficulty and the expectation was that he would return to symptomatic … Read More

General Advice Hysterical Orthopaedics The word “hysteria” has specific psychiatric connotations.  Patients who are thought to suffer with hysteria sometimes present with so-called conversion disorders. In the orthopaedic paradigm, patients may present with fixed contractures, for example of a hand … Read More

Lead Article Social and Recreational Activities Whilst most attention in personal injury and medical negligence claims focusses upon impairment assessments, causation, economic loss and future therapeutic needs, it is also reasonable to assess losses of social and recreational enjoyment that … Read More

General Advice The Expert in Court – How Should She/He Behave? Respectfully! Just as you are likely to feel uncomfortable in an operating theatre (as a patient or as an observer), so do most medical experts feel uncomfortable in a … Read More

Case Vignette Just How Innocuous Is A Tibial Fracture? A 17 year old boy on a work experience programme at a cattle station in the Northern Territory fell from a horse.  He sustained a fracture of his left tibia (shin … Read More

Lead Article Economic Losses Associated With Personal Injury and Medical Negligence This is likely to be your big ticket item.  Losses that have accrued following an injury and those that are likely to accrue in the future can amount to … Read More

General Advice May 2017:  “Court Directed Concurrent Expert Evidence – Just How Hot Can The Tub Get?” The word “conclave” comes from “cum clave” which is Latin for “with a key”.  The term “hot tub” comes from that special environment … Read More

Case Vignette May 2017:  “The Unstable Back” Spondylolisthesis is a term which refers to the forward slippage of one vertebral body on the subjacent vertebral body.  “Spondylo” is from ancient Greek and refers to the spine and “listhesis” refers to … Read More

Lead Article May 2017:  “Impairment Assessments – When, How and Why? Impairment relates to a loss, loss of use or derangement of any body part, organ system or organ function.  The definition includes objectively identifiable impairments such as those due … Read More

Case Vignette Whiplash, Whiplash, Whiplash…..   I hate the term “whiplash”!  It conjours up a vision of a rodeo rider, standing in the middle of a heavily-hoofed, sandy ring, wearing his chaps and flailing a whip above his head.  As … Read More

Lead Article Causation versus Liability in Personal Injury Litigation It is best to be clear at the outset. Your orthopaedic expert can definitely assist you in determining the presence or otherwise of causation.  Conversely, liability is strictly in the legal … Read More

General Advice How To Choose Your Medicolegal Expert Wisely! Experts come in many forms.  They can be hawks or doves, bleeding hearts or little Hitlers, pushovers or aggressive adversaries.  Whatever the description, you don’t want to be dealing with one … Read More