Interview with Acute Medicine and General Medicine Expert Witness

An interview with our Expert Witness Mr Phillip Jacobs

Join us as we interview a member of our panel, our General Medicine Expert Witness.

Dr Phil Jacobs is an examiner for the Royal College of Physicians and University College London Medical School and has presented work at international conferences, published articles in peer-reviewed journals alongside participating in the peer review process of submitted manuscripts.

Thank you for speaking to us. Could you please tell us a little about your medical background?

During my early hospital training I spent time on an acute medical unit as well as in various medical specialties. Not all junior doctors enjoy being on-call and dealing with emergencies, as it is invariably busy and can be stressful, but it is a rich learning environment and an opportunity to get first-hand experience in the management of acutely ill patients, working within a supportive multi-disciplinary team. The range of clinical problems encountered is vast and I really enjoyed the wide variety of patient presentations to which I was exposed. 

What made you choose to work as a consultant in Acute and General Medicine?

After completing my postgraduate general medical training, I was unsure which career path to take, and I did not want to specialise in one particular organ related specialty. I decided to take some time out of the NHS by travelling round the world and working abroad. I worked as a medical registrar in Auckland, New Zealand. The experience was similar to working in the UK, although the large Māori population in Auckland meant that there were some interesting cases that I had not previously encountered.

When I returned to the UK the first specialty training posts in Acute and General Medicine were being offered. It was and remains an exciting time in acute medicine and the specialty has grown to encompass Ambulatory Emergency Care which involves managing lower risk patients who do not require hospital admission such as DVT, cellulitis, low risk PE (pulmonary embolism), pneumonia, acute kidney injury and deranged liver function. Acute Medicine also includes the care of acutely unwell patients who cannot safely be managed on a normal hospital ward but are not unwell enough to require ITU. These areas are called Enhanced Care Units and patients benefit from the close monitoring that can be provided as well as the higher ratio of nursing care. 

I note that you have special interests in sepsis and pulmonary embolism, can you tell us a little about this?

I have been the hospital lead for simulation training which originated in other safety critical industries such as airlines. Emergency scenarios can be recreated in a safe environment and clinical and non-technical skills can be acquired such as leadership, teamwork and communication. One of the scenarios we recreated was the management of sepsis. I was involved in the peer review of UK wide cases of sepsis for the National Confidential Enquiry into Patient Outcomes and Deaths (NCEPOD) and I adapted the NICE sepsis guideline for use within our Trust. Fortunately, there is a now a lot more awareness of sepsis amongst both clinicians and the lay public.

I also worked with NCEPOD on their Pulmonary Embolism report and I was one of the authors of the British Thoracic Society Quality Standards for outpatient management of pulmonary embolism. I was subsequently involved in redesigning our Trust pathway for the management of PE.

Why would an expert witness report in Acute and General Medicine be needed?

When an adult patient is referred by their GP as an emergency to hospital, or by the Emergency Department, unless they have a surgical or pregnancy related problem, they are most often referred to the acute medical team for assessment, diagnosis and treatment. Many of these patients are admitted or discharged from hospital under the supervision of an acute physician or general physician. Some are referred on to organ-based specialty teams such as cardiology, respiratory, gastroenterology, and older, more frail patients are subsequently managed by geriatric medicine physicians, but even these patients will usually have been cared for by acute and general physicians during their inpatient journey. 

Acute illness and hospital admission is obviously not without risk and if harm is alleged then an expert in acute and general medicine can determine whether care has fallen below an acceptable standard.

What attracted you to writing expert witness reports? And how did you obtain the qualification/accreditation to do so?

I have been involved in the retrospective review of clinical records since I was a trainee doing clinical audit and various quality improvement projects. Shortly after starting my consultant post, I undertook training in “root cause analysis” and led investigations into serious untoward incidents. As well as the work I have done with NCEPOD, I was recently appointed to the role of medical examiner. This involves the independent scrutiny of medical records to establish causes of death, liaising with the clinical team involved with the care of the deceased, and the deceased’s family. Coroner referrals are made when necessary and clinical governance issues are also flagged up as and when appropriate. 

The experience that I have acquired in these roles is very similar to the detailed, critical analysis and report writing skills that are required for clinical negligence reports. Knowledge of guidelines that are essential in my clinical practice can also be applied to report writing when discussing expected standards of care in Breach of Duty/Causation reports, and I enjoy seeing patients alongside the statistical analysis and review of scientific literature that is required for Condition & Prognosis and Life Expectancy reports.

A colleague introduced me to a medico-legal agency and after writing several screening or advisory reports I participated in a course which covered civil procedure rules, case law, data protection, report writing and court room skills. 

What would you say to medical professionals looking to undertake expert witness work?

There is a wealth of opportunities as a clinician that can be acquired to gain the skillset needed for expert witness work. I would not rush in to expert witness work within the first few years as a consultant because it is important to settle into the new consultant role. 

Some experts undertake formal legal qualifications but doing a course, CPD and undertaking screening reports are great preparation for taking on more complex work and the communication skills acquired in clinical practice can be applied to joint expert meetings, conferences with Counsel and giving evidence. However, I recommend a course to prepare for cross-examination which is not that dissimilar from the undergraduate experience of being quizzed in a lecture theatre full of ones’ peers by the Professor of Medicine! Finally, the learning that I have gained from expert witness work has been invaluable and reinforces safer clinical practice. 

Dr Phillip Jacobs

Dr Phil Jacobs is an experienced physician with dual certification in acute medicine and general internal medicine. He has been a medical expert since 2015 and has experience of a wide range of medical expert reports.

Instructing Dr Phil Jacobs

If you want to instruct Dr Jacobs or if you want to discuss using Dr Jacobs for your case, please contact us.