Book review: The Geriatrician in Court
Dr Shane O’Hanlon is a consultant geriatrician and Honorary Secretary of the BGS. He holds a law degree and has a special interest in medicolegal matters. He tweets @drohanlon
Most doctors spend their career hoping never to see the inside of a courtroom! While geriatricians are probably among the most rarely sued specialists, we can still have quite frequent involvement with the law – the Coroner’s Court is a good example. There is also an increasing amount of medico-legal work related to dementia, deprivation of liberty safeguards and mental capacity. In this environment there has been a gap in the market for a book that focuses specifically on our needs, but retired geriatrician Dr Geoffrey Phillips is at hand with help.
“The Geriatrician in Court” is a handbook of “how to do it” based upon his thirty years of experience in preparing medico-legal reports and attending court to give expert evidence. The book covers all the main topics over the course of 226 pages. It begins with an outline of the legal system, criminal versus civil law, negligence and burden of proof. Important areas such as mental capacity, testamentary capacity, abuse, medical error and resuscitation all feature. He devotes a chapter to the (sadly) increasingly common area of gross negligence manslaughter – where doctors can be prosecuted by the state and be imprisoned for their mistakes.
The most refreshing angle here is that Phillips takes us through many cases in great detail, which gives an insight into the medico-legal preparation work needed before appearing as a witness. His reports are reproduced with all aspects of the case discussed and this offers really useful examples of how to approach presentation of pertinent information. His thought process is clearly laid out and he comes across as being very sensible – a good role model for anyone hoping to enter this area! Lots of basic medical information is set out in an easily comprehensible manner, which helps the reader to know which level to pitch their reports at “for the benefit of the court”.
Some of the cases cover familiar ground: pressure ulcers and the complexities of tube feeding. Others involve more challenging topics such as the man with dementia who killed his wife. For those with an interest in darker subject matter, Phillips also offers suggestions on other sources that are probably a fascinating read such as the book titled “Insulin Murders”…
It’s also fascinating to hear about his interactions with the legal profession and the police force. In some cases investigation and prosecution was stopped by medical evidence, such as when death from dehydration in a frail patient with advancing dementia was erroneously seen as abuse on the part of staff. He also notes the sad truth that behind the scenes in some cases there is a relative in denial of human mortality; possibly resulting in inappropriately prolonged legal proceedings.
Although the book and the law it considers relate to cases in England & Wales, it will be helpful to physicians involved in medico-legal work in many countries. He gives detailed requirements for those who wish to take on expert review and provides guidance on the content of reports that need to be produced. General Medical Council investigations are also covered. One of the most useful sections is when the actual process of being an expert in court is explained, including how and when you will give evidence, as well as details of interactions with the judge, lawyers and other expert witnesses.
Overall I really enjoyed reading Phillips’ observations – the book flows like a memoir and there are really useful nuggets to be found. This has the advantage of making it more accessible than textbooks, though it is less formally structured as a result. I imagine that interested geriatricians will read it from start to finish rather than dipping in as they might with a reference book. For anyone considering medico-legal work it will prove to be extremely valuable.