Operating Within the Law. A Practical Guide for Surgeons and Lawyers
====================================================================

* Douglas F. Birt

Operating Within The Law. A Practical Guide For Surgeons And Lawyers. Bruce Campbell, Ken Callum and Nicholas A. Peacock. 254 pp. tfm Publishing Limited, Shifnal, Shropshire, UK. 2001. Paperbound. £24.95. ISBN 1-903378-05-2

The authors of this British publication are 2 consultant vascular and general surgeons — Professors Campbell from the University of Exeter and Callum from the Derbyshire Royal Infirmary — and a barrister — Nicholas Leacock from London. The volume is a clear, concise outline for physicians and lawyers concerning the full spectrum of medicolegal issues in clinical practice. Because of its small size (190 pages of main text) the book makes an excellent guideline or handbook reference.

The book starts by listing the problems of worsening medicolegal activity and describes the stress it places on physicians. Graphs are provided for settled cases and the accumulated costs for claims made between 1990 and 1998. Orthopedic surgery and trauma are the most expensive in the United Kingdom, accounting for 38% of all costs, followed by obstetrics and gynecology representing 19%. This is in contrast to the Canadian experience where obstetrics and gynecology are associated with the highest costs, mainly because of awards for compromised babies.

The chapter on the anatomy of a legal claim is important reading for all physicians. It covers the issues of duty of care, law or policy, burden and standard of proof, breach of duty and causation. Many of these terms are unfamiliar to physicians but are explained with interesting examples.

The section on avoiding medical legal problems is a must read. It outlines the use and help of risk management, guidelines or care path maps, consent and what constitutes informed consent. It also stresses the need for documentation and record-keeping.

Another section describes the physician as a defendant. It goes over the impact and response to receiving a complaint or a suit. The personal burden and the impact on a physician’s practice and career are well described. This is followed by a section on the physician as an expert, which presents helpful guidelines for writing medicolegal reports and appearing in court as an expert witness.

A useful medical glossary is provided and, for physicians, a more important legal glossary. The book ends with a list of Web sites, which are only British, and a useful section on all the ramifications of informed consent.

Overall, this book is helpful, concise and is in a format that allows for quick reference. Although British-based, it parallels the Canadian experience. It should help in minimizing physicians’ exposure to medicolegal liability. It will help educate physicians faced with an adverse patient outcome, complaint or suit and better prepare them for the steps required in the defence of their integrity and reputation.