Susan, I sense, may well have been a doctor at the forefront of her profession when she left it.

I have always been very keen on finding out why the patient has come – but not every doctor does so.

It is of ocurse vital to engagement and indeed moving forward.

We know little of coaching as doctors although, I sense, coaching takes this to another level.

All good wishes
Clive

Negligence consists of a breach in the standard of care, damage and causation.

The most difficult obstacle for any potential litigant is to prove that the damage they suffered is due to negligence.

The standard legal “but for” (what was done caused the damage sustained) test is very difficult to prove.

The extensive early caselaw (Whitehouse v Jordan, Sidaway v Bethlem, Pearce v United Bristols Hospitals, Hotson v East Berkshire; Gregg v Scott demonstrates what a lottery negligence actions can be.

However, recent UK caselaw (Chester v Ashfar) & Australian caselaw has shifted the balance of power from the Bolam test of medical negligence (a body of medical opinion) to the “Prudent Patient” test.

The “No Fault” compensation legislation in New Zealand doesn’t really solve this problem. It is expensive and underfunded.

Other more attempts to replace the unpredictable Tort approach by a Strict Liability alternative, such as the NHS Redress Act are feeble attempts to adequately compensate victims of medical accidents, regardless of whether there is negligence.

I agree with Susan, the removal of legal aid will make it more difficult for potential litigants to pursue their cases to the higher courts, a step that is often required to overcome the resistance of NHS Trusts and PCT to accept blame and the continued efforts of the Medical Defence bodies to assist their members.

The class actions following thalidomide, Opren, and the benzodiazepine actions were all prolonged and hazardous for patients with phocomelia, renal and hepatic failure and addiction.

ICI wisely introduced a “No Fault Compensation” scheme to compensate the victims of practolol toxicity.

The more recent clinical trial disaster with a new immonological compound that occured at Northwick Park led to the bankruptcy of the manufacturer. There is no point in trying to sue a “Man of Straw”.

Medical Negligence law is complicated and damaged patients require specialist legal expertise to trawl their way through the many potential minefields.

Expert medical lawyers who are prepared to work “pro-bon” or on a “No Win-No Fee” basis may be difficult to find.

Teh stress of prolonged battles through the courts is likely to add to the considerable distress many patients face when trying to find their way through what is a Byzantine legal system.

Critical Incidents which may or may not be due to medical negligence still occur despite the efforts of the NPSA, local Clinical Governance, Audit and other attempts to reduce these.

Probably the AvMA (Association of Victims of Medical Accidents) is the most experienced charity to assist the victims of medical negligence.

They have a vast database of successful actions and who offer considerable support to damaged patients.

In conclusion, the major hazard now faced by every practitioner is not the problem of medical negligence, but the rigour of the regulators and their employers in pursuing those trying to provide a good standard of care for their patients.

Professors Sir Roy Meadow, David Southall (Child Protection), Steve Bolsin (Bristol), Dr Kim Holt (Baby P), Dr Raj Mattu, Dr Eva Michalek, and many others too numerous to name can testify to their personal experience of the consequences to their careers after trying to improve patient care.

Their lives and careers have been systematically destroyed by the relentless, unaccountable, taxpayer funded and expensive pursuit of their employers.

The second is impossible.

As for the third ; some doctors enjoy this. I tend not to be one of them.

It would be interesting to hear from dr who manage the second challenge. I sense that a fulfille d life outside Medicine is important. I sense too that leaving work and going home properly is important. Perhaps too confidence in what we do is important – I have worked with colleagues who constantly doubt themselves…….. May be too we need to acknowledeg that we are not omniscient,,,,,,,,,,,,

All gd wishes
Clive

I am a dichotomous thinker but I know that Susan most certainly is not……………..

Of course we all leave Medicine when we retire or do we ? Drs used to enjoy cheap / free GMC registration in retirement although no more. There is discussion at the moment on Drs Net about the title.

This gets me thinking how we introduce ourselves. I think that I have written before that most of my mail comes to Mr rather than Dr and all my credit cards ( bar one) are Mr. Yet others know me as “Clive who is a doctor” even though I try very hard not be a doctor.

I am proud to be a doctor and do not shirk from the role but am also conscious that it is only a prt of me.

All gd wishes Clive