Anna Holdgate has been a FACEM for more than twenty years. In those years she’s had many roles – clinician, director of emergency medicine, director of emergency medicine training and director of research. She’s completed Master’s degrees in Health Law and Research.
But for the past five years, in addition to ongoing clinical practice, Anna has found her groove in medico–legal work.
‘It’s something I developed an interest in after a trainee at my hospital had a bad experience,’ Anna says.
‘She was the only person in the room who did not have their own legal representation.’
The trainee was being represented by the hospital’s lawyers.
‘There was this notion she was being protected by the hospital, but of course the hospital must protect its own interests too. Those interests do not always align.’
Anna pursued training in this area of work and now works as an expert witness in NSW coronial inquests and other medicolegal matters.
‘I met a few people through my Health Law course, prepared a few reports. It’s fairly ad hoc in that once you are known by barristers you tend to get these opportunities.’
She says she is very conscious of expressing her opinion on the conduct of her colleagues but believes the public has the right to know when things could be done better. She also strongly believes that the legal system has a poor understanding of the uncertainties and challenges that clinicians face in their daily practice.
‘A coronial inquiry always happens in isolation, focusing on when something has gone wrong without acknowledging that most of the time everything goes right . I look to give these circumstances a normalised context. Ok, this happened here – but what would happen normally?’
Anna herself has never been the subject of a coronial inquiry, but says about eight per cent of doctors will one day be in that situation.
‘Usually it isn’t because someone is a bad doctor.’
Her advice to anyone who is subject to these inquiries is to contact your medical defence organisation as soon as possible. And to never attend a court hearing without legal representation, which should be provided by your MDO.
‘There are interests at play that are not always yours. Costs, reputation. These are things you also need to protect for yourself.’
She says most MDOs will have an emergency physician working for them who can provide immediate advice.
For locums, Anna says contracts vary enormously from place to place and state to state. Not all locums are covered by the hospital’s public liability insurance. ‘Locums and contractors need to check if they have appropriate liability insurance. Not just in case you are sued or involved in an inquest, but in case you are injured at work. I know of instances where there has been no coverage for a locum injured at work, despite having a long working relationship with the hospital.’
Anna says for the most part the cases she has assessed would have turned out very differently if doctors had followed three rules. She says you can often keep out of trouble by:
- avoiding making an absolute diagnosis when there isn’t one, it’s safer to express uncertainty which leaves the door open if the clinical situation changes;
- sending patients home with a clear, documented plan outlining the expected progress of the illness and a timeline for follow up; and
- giving patients clear and specific criteria to return to the emergency department if things change.