Improving the health of the solicitor-expert relationship

As a medical expert
often asked to produce medical reports, I am frequently dismayed at the quality of notes received. This is partly because of the overall poor quality of notes currently held within our hospitals, but there are two major pitfalls that can be avoided by solicitors.

Full disclosure

The first is that you must request a separate copy of the records held on computer, including all pathology reports; that is clinical biochemistry, haematology, microbiology, immunology, virology, histopathology and radiology, including nuclear medicine reports.

Further, when asking for
these, ask for records dating back at least five years as there may
be abnormalities very pertinent
to the case that were ignored previously. Keep the computerised records with the main medical records relevant to the case.

Why is this necessary, when we request a full disclosure of the records? Hospitals are inundated with requests for copies of the medical records, and so they simply comply
with the letter of request and photocopy the notes; but we
no longer have printed copies
of results in the notes.

Therefore, at a later stage,
your expert will be struggling
to compose a report with no clear evidence of investigation. At worse, they will produce a report on inadequate records relying on results hand written in the notes; at best, the case is delayed further while appropriate new requests are made.

Despite such requests, one can still find intransigence.
I was once writing a report for
a coroner on a patient who died from sepsis in intensive care and, despite multiple attempts,
we could get no microbiology results from the trust, but I knew there had to be further data. Therefore, I emailed the medical director of the trust advising him that my report was going to be submitted and would conclude gross negligence on their part since they had not undertaken any blood cultures. We received all microbiology results the
next day.

Outside company

The second pitfall is the increasing use of an outside company to redact the notes. Sometimes these are done well, but for big cases it can cause major problems for experts to try and unravel everything that has been filed in separate sections, with no clear recognition of the need to keep everything together.

Recently, I could not find any blood results, only to find that they were in the very last section of two lever arch files, carefully separated from the main notes. For hospital cases, there is usually a clear start and finish date to the event. It is much better to have all of the records that relate to such an admission together, including clinical episodes seen and dealt with by other specialties and subsequent follow up.

If you are going to have notes redacted, then ask the company to refile all duplicate submissions and blank sheets or forms separately. Often one finds the same letter three or more times faithfully copied and filed together. When more than one hospital is involved keep the records separate, some redactors mix them up together.

When I am trying to get to grips with a case, I read the statements and then look at the handwritten notes. I tend to tabulate the pathology results on an excel spreadsheet for ease of use later, I look at the drug and fluid charts, and then I read the typed letters and summaries.

Where there is possible negligence involved and the case is not clear, I look at everything, including nursing notes, and the temperature, fluids and BP chart. It can sometimes be difficult to find something, particularly when you are looking for something that is missing. It is much better
if all the records relating to that admission are together.

Overall, when collecting information from separate sources, I would recommend one file for GP records, separate files for each hospital, and, in particular, a separate file that relates to the hospital admission in question, that includes all of the results. SJ

Kevin Moore is a professor of hepatology at University College London