The choice of a medical expert can be pivotal to a successful outcome in a case. Selecting the wrong discipline of expert can be costly and embarrassing for the instructing party.
Often a wrong choice can stem from not appreciating the finer details of the distinction that exists within a medical discipline. Psychiatric/psychological illness and back/spine injuries are two such areas where confusion can occur and we will attempt here to dispel that.
Psychiatry vs psychology
Psychiatrists are medically trained doctors who study the diagnosis, treatment and prevention of recognised mental and emotional disorders. Where a psychiatric illness such as post-traumatic stress disorder (PTSD) is alleged to have arisen following an injury or trauma, it is often appropriate to instruct a psychiatrist to provide an expert opinion on the causal link between the two events.
If the claim involves an injury to the brain, spine or central nervous system, a neuropsychiatrist should be instructed. They are medically trained psychiatrists but specialise in psychiatric illnesses which arise out of injuries such as these.
Psychologists on the other hand are concerned with the study of people and, in particular, their behaviour and how their minds work. Psychologists do not have to be medically qualified and there is a wide range of specialism and different levels of qualification. It is important to clarify the distinction between clinical psychologists and counselling psychologists. Both are governed by the British Psychological Society, with separate registers for chartered clinical psychologists and chartered counselling psychologists. Whilst only a three year degree is needed to be a psychologist, to become chartered it is necessary to complete an accredited post-graduate professional training course along with a period of supervised practice.
In general terms, a clinical psychologist is concerned with the diagnosis of disorders such as anxiety and depression while a counselling psychologist is better placed to provide a report on the treatment of disorders. Psychologists are not able to prescribe drugs or other medical treatment which psychiatrists can but they can suggest alternatives such as cognitive behavioural therapy.
Whilst there is on occasion overlap between the disciplines of psychiatry and psychology, most defendants are wary of instructing a psychologist or accepting them when they are nominated by the claimant. A report from a psychiatrist is likely to carry more weight when considering the medical science behind diagnosis and causation of a psychiatric illness. For example, when seeking an expert opinion on whether PTSD has been caused by a road traffic accident it would be possible to instruct either a psychiatrist or a clinical psychologist. However, should causation issues develop which require a more rigorous analysis of the condition, a medically qualified psychiatrist will be better placed to provide evidence.
There are however situations where a psychologist may be more appropriate. When considering the developmental needs of an individual and the treatment required going forward, whilst some psychiatrists will have additional training in such therapy, a psychologist may typically have more experience in this area.
Orthopaedic surgeon vs neurosurgeon
Identifying the right type of expert in cases involving back or spinal injuries has become increasingly complicated. Long gone are the days where you would simply be referred to a general orthopaedic surgeon if you had back pain. The spine has increasingly seen new breeds of medical practitioners specialising in its problems. This in turn causes confusion in the claims world when selecting a medical expert.
An orthopaedic surgeon deals with the diagnosis, treatment and care of patients who have suffered trauma. They will generally concentrate on bones and joints. Orthopaedic surgeons have come to specialise increasingly on a particular part of the body. An orthopaedic spinal surgeon, for example, is one that specialises in dealing with problems with the spine.
Neurosurgeons specialise in the prevention, diagnosis, treatment and rehabilitation of injuries affecting the nervous system including the brain, spinal cord, and nerves.
Both orthopaedic surgeons and neurosurgeons are qualified to carry out spinal surgery. As a rule of thumb, where the correction required is to the bony structure of the spine, an orthopaedic surgeon will generally be more appropriate. Where there is damage to the central nervous system, a neurosurgeon will normally be more suitable.
It is always important to consider the claimant’s symptoms. If fractures or structural issues in the spine are the issue, a spinal surgeon with an orthopaedic background is advisable. If however the nervous symptom is involved, such as a prolapsed disc causing compression of nerve roots and sciatica, a neurosurgeon or a spinal surgeon with neurosurgical training would be the expert of choice.
Getting it right
As with any instruction, it is important to carefully consider the precise requirements of the report before proceeding to select and instruct an expert. It is vital to have a clear idea of what arguments you are intending to advance and then consider which expert or experts will be best qualified to provide an informed opinion to support those arguments. By understanding the distinction between different types of experts, you will maximise your prospects of obtaining the desired outcome.