PI Brief Update

How Should Medical Experts be Regulated? - Dr Mark Burgin

26/03/19. Dr. Mark Burgin BM BCh (oxon) MRCGP explains the options for regulation of medical experts and the importance of regulations to support the quality in their work.

There is an adage that says you can have quick, cheap and good but not all three and this applies to the current state of medical expert reporting.

With the focus on service level agreements (SLA) and containing costs there has been less interest in ensuring that the product is of high quality.

I have written about the importance of medical expert report audits MERA as a tool in improving performance but the system remains dysfunctional. (1)

Experts should receive regular feedback (1% of their reports), have regular formative CPD and support to challenge regulations that prevent high quality work.

Medical Expert Report Audits MERA

MERA provides three measures that together provide gold standard support for the expert to understand how to improve from good enough to excellent.

Compliance with CPR35 is patchy and typically is due to poor understanding by experts of how to apply the legal requirements and an understandable preference for medical language.

Most reports provide enough evidence to support the opinions but are less good at dealing with inconsistencies and explaining the expert’s logic.

All experts can benefit from recommendations as to how to improve their reports from a senior colleague whether to update parts of the template or include missing material details.

Knowledge Examinations and CPD

Giving the expert an opportunity to demonstrate their knowledge in a high stakes pass-fail examination is useful to show expertise.

Having an examination which picks out areas of weakness and strength has additional benefits when the expert is planning their continuing professional development (CPD).

The main difference between summative (pass-fail) and formative (feedback) assessments is that those who undergo formative assessments are more likely to continue learning.

I have written a number of articles that address the breadth of problems that arise in personal injury cases and could be used as a basis for a CPD program. (2)

Criterion based assessment

There are many criteria for experts to follow from the GMC good medical practice 2013 to CPR35, PD35 and the guidance to contractual terms from agencies, solicitors and MedCo.

Some are unduly restrictive such as requirements to return reports within 24 hours and some are too vague such as indemnifying agencies against any losses, others are just arbitrary.

In any event if the criterion is arbitrarily applied and there is no overarching authority, any good that these criteria could do is transformed into an obstruction to the expert’s duty to the court.

Any inspection should therefore identify criteria which are obstructing the expert from providing a flexible responsive service based upon the claimants’ and the court’s needs.

Conclusions

There should be presumption against any new rules in PI but particularly those that restrict the flexibility of experts to provide what the market and the court wants.

Any criterion based assessment such as inspections should be focused upon ensuring that the expert is not encumbered by requirements preventing them from assisting the court.

All experts should receive feedback on their work so that they can improve the quality of their reports even if this leads to an increase in their fees.

The proposed CPD program should be based upon those aspects of PI work that create problems for experts and should be designed to encourage further learning.

Doctor Mark Burgin, BM BCh (oxon) MRCGP is on the General Practitioner Specialist Register.

Dr. Burgin can be contacted on This email address is being protected from spambots. You need JavaScript enabled to view it. and 0845 331 3304 website drmarkburgin.co.uk

1. Dr Mark Burgin 2018 Medical Expert Report Audit (MERA): Opening the Black Box www.pibriefupdate.com

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