[log in to unmask] wrote:
>
> In a message dated 17/08/96  07:22:28, you write:
>
> >Trefor is right about there being no need to be perfect (notwithstanding
> >the many contributors to this list who have recently indicated for my
> >benefit how they see this as a preconditon to membership of the medical
> >profession). However, it is not always the case that the test is
> >assessed according to the level of 'training and experience'.
>
> <snip>
>
> >Sometimes the court will take into account the level of training and
> experience
> >expected by the patient. I can't recall the case name
>
> The latter case name is Whirtehouse v Jordan

No, I was not referring to that case.


> The difference between the Bolam test  and the ruling in Whitehouse against
> Jordan is one of competance. The whitehouse/jordan case revolved around a
> registrar who was called to a delivery and failed to provide the highest
> standard of care available. He was judged not to be nelgigent because he was
> not expected to be as good as the best possible doctor in his field, only as
> good as the average for his grade.

You have missed the point, in fact both of them, and misunderstood the
law:-

1. The test is  not to be "average". That would leave half of all
doctors,by definition, guilty of negligence. You can be substantially
well below "average" and still not be negligent. The test is simply
whether a responsible body of opinion supports the actions taken.
Another way of looking it at it is that if the average doctor takes a
particular step in certain circumstances, it is not negligent to not
take that step if a responsible body, but not massive number of, other
doctors would not take that step.

2. Whilst the "responsible body" is a body of similar training and
experience to the Defendant doctor (eg so a GP will not be judged in his
treatment of a supposedly depressed patient by the standards of a
consultant psychiatrist) neverthless there are limits to that principle
in that, in certain circumstances, the patient is entitled to expect a
minimum level of "responsible body" competence. For example, if a
fundamental error is made in keyhole surgery such as no surgeon trained
in the technique would have made, it is no defence for that surgeon to
claim he had not been trained at all in keyhole surgery nor carried out
any previous keyhole operation. The patient was entitled to expect that
he had such training and so his competence would be adjudged
accordingly.  This is to be compared with the example you chose in that
in obstetrics, the very emergency of the circumstances may be  such that
the patient must expect the "responsible body" to vary according to who
is available at the time, whether consultant obstetrician, registrar, or
midwife.

>I have not consulted any textbook to type these postings. I need them >in my head to teach medical students.

Your students desperately need a lawyer to teach them not a doctor with
books in his head and a brother for advice.


>  Please Consider your position on this message board, and perhaps in the
> medico-legal field as a whole.

Thank you and I have considered them both and the thought is :-

1. Lawyers on this board can  help the medics avoid misinfornming
themselves on the law...just as I prefer to listen to doctors on the
medical aspects of the area of work in which I practice (which is why I
am here).

2. As to the medico-legal field I enjoy it and gain much satisfaction
from it.

Anything else you want me to consider?

>
> >Maybe a swop for a week would be interesting.Any offers?
>
> Go on then

Ok. Can I suggest the week at your surgery? Obviously you will have to
be there, (ie the swops will not be concurrent) so you should let me
have the dates of your holidays etc. I shall check my diary on Tuesday
and e-mail you privately with suitable week's in my office.

There will need to some rules. To reply to one posting,we will both have
to honour the confidences of our clients/patients and indeed you will
have the benefit of knowing that I would not, as a result, be able to
take an instruction from any of your patients (I will have to check with
my staff that we have no case against you ongoing as I couldn't do it in
those circumstances).

We should agree, as someone else has suggested, to a certain public
element, ie the exchange could be covered by a journalist. We should
agree to an audit of those aspects of misunderstanding that were cleared
up. Perhaps a list of questions could be replied to at the outset and
again at the end of the exercise.


Graham Ross


%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%