84 LAWYER MONTHLY EXPERT WITNESS AWARDS 2025 With over 30 years of experience in writing expert reports on clinical negligence, how has the landscape of obstetrics and gynaecology evolved, and what key changes have you observed in medicolegal cases? Many changes have taken place in Obstetrics and Gynaecology, especially in terms of the increase in subspecialisation. Whilst this can be regarded as a good thing, it has introduced areas of negligence where there has been insufficient appreciation of the patient as a whole. When I started working as a consultant, I expected myself to be an expert in all areas of the speciality, including surgery for gynaecological cancer. Since then, with increasing subspecialisation, many consultants have developed limited areas of practice, with some doing only obstetrics and others only gynaecology. The implication is that a consultant in O&G should only prepare medicolegal reports for the areas in which they practice and have expertise. However, generalist experience is still important, if patients have multiple problems, which do not fit into the pigeonhole of one subspeciality. The process of consent for surgery and other treatments has changed completely over the last 30 years. The traditional practice would be for consultants to recommend the best treatment that they could offer for the patient’s condition. There was also the concept that consultants would take overall responsibility for “their patients.” Currently, consultants are obliged to explain the benefits and risks of a range of different operations, as well as conservative options and no treatment. Patients should be given leaflets and be allowed to choose the option that suits their circumstances and lifestyle (as per the Montgomery judgement in 2015). However, the process of consent is not straightforward. It has been shown that patients only remember 40% or less of what they are told in a consultation, so discussing multiple options makes becoming “fully informed” even more difficult. Patients also have widely varying concepts of risk, with some refusing necessary surgery, even when told it is safe. Others seem determined to go ahead with surgery, even if they are warned of significant risks. Many decisions about surgery are now made in “MultiDisciplinary Team” (MDT) meetings, at which the patient is not present, comprising healthcare professionals, who have never met her, leading to risks of misunderstanding. As a Consultant Obstetrician and Gynaecologist at Western Sussex Hospitals NHS Foundation Trust since 1992, how has your clinical practice informed your approach to medicolegal reporting? My clinical training started in 1978, and I aimed for a “double qualification” in general surgery and O&G, which was common amongst the consultants that I worked for. Spending four years in general surgery and urology gave me invaluable experience of surgical techniques. On returning to O&G, I worked at several centres of excellence in London, including Queen Charlottes Hospital, the Chelsea Hospital for Women, Guy’s Hospital, and ended as Senior Registrar at St Bartholomew’s Hospital. Thus, 14 years of clinical training with a broad experience of obstetrics and gynaecology was the foundation for starting medicolegal work in 1992. On being appointed as a consultant at the age of 39, I joined a small team of 2 consultants responsible for 2,500 deliveries at Worthing Hospital and soon became Clinical Director for Women’s and Children’s services. This responsibility made me aware of the complexity of maintaining standards and improving services. For
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