All of our Orthopaedic expert witnesses are not only highly respected in their field but also have the skills and certification required to write unbiased expert reports that can assist the court. One of our panel, Mr Nicolas Gillham, BM BCh, MA, FRCS Ed, FRCS Ed Orth, who qualified from Cambridge and Oxford Universities, sat down with us to talk about his role as an orthopaedic expert witness, his interests in forensics, and the most common mistakes he believes are made by health professionals when things go wrong.
Thank you for speaking to us Nicholas. Why did you decide to become an expert witness?
Unfortunately, medicine is not the same profession as it was 50 years ago in terms of financial stability. Also, there are several private orthopaedic practices in Banbury and Oxford where I live so the area is well serviced and very competitive. I built up my medico-legal work slowly and after a time began to receive more and more referrals. I have been preparing expert reports for over 30 years and concentrate on the niche areas of the upper limbs and ankle.
What is the process you follow when preparing a report?
Most cases are uncontroversial, however, in minor RTA whiplash claims you do come across claimants who are untruthful about the extent of their pain and disability. This can make it difficult to quantify damages. Thanks to over three decades of experience I can quickly spot in someone’s medical records if they have had a history of making claims, have a pre-existing injury or is simply telling outright lies.
I actually do very few soft-tissue claims as my focus has shifted to writing reports on complex cases involving long term medical complications. Medical negligence cases also encompass an increasing part of my medico-legal work. Part of my job is to establish causation – for example, just because a doctor missed diagnosing a fracture does not mean that this caused the complications. Causation is incredibly important to establish and in complex cases something that can only be done by examining the claimant in person and meticulously analysing their medical records and imaging.
Another area of interest is sports-related injuries. Both my daughters are sportswomen (equestrian and skiing) and I have acted as the course doctor for several sporting events, mostly equestrian, and have a passionate interest in encouraging safety at sporting events.
After 30 years you must have built up relationships that assist you with writing expert reports?
Absolutely – one of the most important is being able to organise appropriate imaging so I can provide an accurate assessment of the types of long term complications a claimant may suffer, for example, arthritis or the need for further surgery. I have built up relationships with some of the country’s best radiologists who can provide high-quality images. This enables me to make a more accurate assessment of the claim.
What is the most common mistake you see health professionals making that leads to medical negligence claims?
The old cliché that everyone makes mistakes, it is how you deal with them that makes the difference, is 100% true. Things can go horribly wrong when a mistake is made and the health professional/s responsible try to cover things up. Following the correct procedures is vital, for example, if surgery is required to correct the mistake make sure that the patient is seen by an independent consultant who was not involved in the original procedure before they go into theatre.
What are your main strengths when it comes to creating expert orthopaedic reports?
I take a collaborative approach and make myself available to instructing solicitors. For example, if a claimant is clearly exaggerating the extent of their injury I will pick up the phone and chat things through with the solicitor, so they have a clear understanding of the situation.
Years of experience has taught me that expert reports must be concise, clear, and above all, understandable. Neither solicitors nor the court is interested in receiving a long-winded thesis, they want to see the key points.
Finally, I use voice recognition software so if a report is urgently required I can create one quickly – often on the same day if the case is relatively straightforward and I receive the imagery and medical reports promptly.
Mr Nicholas Gillham is a consultant trauma and orthopaedic surgeon who provides expert evidence in personal injury and medical negligence.
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