Doctors and patients

Changing societal circumstances and expectations have called for a rethinking of the elements of the doctor-patient relationship. This now encompasses not only the traditional compassion of a fatherly healer, but also the satisfaction of a customer, and more recently, the trust of a partner.

This entails enhancing the medical literacy of the patient so that he can be engaged in a more educated choice for a treatment option; not only informed of the benefits and risks, but to a certain extent acquiring some of the medical knowledge which was once held tightly in the privileged possession of the doctor. That is, in order to be an enlightened doctor of the 21st century, he must participate in imparting specialised knowledge not only to the more junior professionals, but also to the patient as a layperson. This has required the doctor to diagnose not only the illness of his patient, but, equally importantly, to diagnose the preference of the patient, now made medically intelligent. Hence, the modern world of healthcare is pushing towards common understanding, interest and shared options.

Doctors and lawyers

Doctors and lawyers are notorious for what can be a feature of their professional language, that is, professional jargon. Doctors can be a little worse, because their jargon when handwritten can become illegible. Legal documents though made neat and orderly with the help of a word processor, can sometimes be difficult to read and comprehend. However, when it comes to medico-legal matters, finding a common language and platform for dialogue is of utmost importance.

I have been engaged in complaint management and liaison for medico-legal cases as a doctor for three years, and have been caught in what can be an adversarial atmosphere even between the doctor and his lawyer. The doctor may be still in a state of defiance, relying on his qualifications and position, not yet appreciating the shakiness of these props in a court of law. The lawyer, on the other hand, has to help the doctor understand not only the rules of the court, but how to better prepare for the hearing. This may include the drafting of a witness statement, which is not purely a clinically oriented medical report. This will entail explanation of highly technical medical terms and will be in the lawyer and doctor's common interest in the management of the case at hand. At the same time, the lawyer should provide assistance to the doctor in preparation for the different stages of the legal proceedings.

Terms such as "letter of claim" or "statement of case" or even what amounts to "negligence" are novel to the usual doctor. For example, "quantum" here refers to money, rather than energy. The lawyer needs to explain to the doctor the meaning, implications and requirements of such legal terminology.

In this way, the paths of the lawyer and doctor converge and a common language to improve mutual understanding becomes crucial.

Expert evidence

A problem that may arise for the lawyer is that multiple medical experts may be simultaneously invited to assess the merits of the case. These reports can come from experts of several disciplines, for example a neurologist, cardiologist and respiratory physician writing on the same patient who has been diagnosed to be in a persistent vegetative state after a failed cardiac intervention, having suffered from repeated pneumonia episodes.

These experts will necessarily be writing from different angles, based on the same set of facts, and the lawyer may have a hard time digesting the contents of highly technical documents, often citing complicated publications. The doctors involved in the claim cannot be requested to assist in the explanation of the contents because of the risk of bias. In these circumstances, an independent doctor who is more of a generalist, not acquainted with the case, can be helpful when considering the content and implications of the reports.

Perception is reality

Different views of the same incident are often held by the involved doctor (defendant), the patient or family member (claimant), and in some cases the lawyers of opposing parties. These perceptions may be divergent, but to each individual party concerned, all are reality.

I have come to understand that facts can be a truth, but minor differences in the sequence of the facts and how these are presented will become another truth. No wonder opposing parties in court can rightfully swear, with equal conscience and solemnity, to tell the truth, and nothing but the truth.

Can a common language be found?

While facts cannot be distorted, they can be framed to allow for different perceptions, perhaps eventually arriving on one version accepted by all parties to form a common basis for resolving a dispute.

Finding a common language involves acknowledging the importance of emotions, appreciating the mitigating effects of a genuine apology, actively listening to versions of the stories from both ends, finding common ground and interests and creating options for solutions. This may in time lead to compensation and/or restoring a broken doctor-patient relationship. The process can be assisted by mediation.

The modern day doctor-patient relationship is one of partnership. In a medico-legal scenario, the evolving doctor-lawyer relationship should equally be that of a trusting partnership, involving shared decision making. Sometimes even the opposing party can tactfully become a partner in the eventual resolution of the conflict. In these ways, a common language will speak for itself and be spoken.

Dr David Dai