The good bad and ugly of medicolegal work

It’s sometimes confronting to look back on difficult times, but if brave enough to do so, one can learn a lot about the choices they made and why they made them. 

I’m sure I was one of many who found themselves pretty lost and wondering about career pivots in 2021 as we emerged from the worst pandemic in modern times. All health professionals struggled with the constant change and uncertainty to our work, flipping from face to face to telehealth, from private practice back into locum work and public hospital roles. When the restrictions were lifted, some were relieved to go back to what they knew and felt familiar after times of immense change.

During that time I worked solely as a “doctor’s doctor”, running a bespoke psychiatry clinic to care for doctors, from medical students to retired consultants. I recognised that we all shared the same issues, caught up in the chaos of frequent changes to the way our roles were performed and experiencing distress and dissatisfaction along the way.

After closing my practice in 2021 I looked around for something else to do. It wasn’t the first time, but it was the most sustained of explorations and I cast the net quite widely. From medical writing, which I’d done for years but fantasised taking to a more serious level, to teaching, to board director roles and to finally putting that CV in at Bunnings to work in the gardening section. 

After some months of obtaining further qualifications I landed into the world of medicolegal practice. A field of medicine that many venture into during their semi-retirement, to “keep their hand in”. An area I now consider to be a sub speciality of medicine, and reserved for clinicians regardless of their retirement decisions, after some substantial years working in their area of clinical expertise.

 I learnt that lawyers value relevance over longevity, and the days of appointing experts with the longest CV’s are over. Relevance and skills in the area of expertise related to the legal matter are valued over who has been practicing their craft for the most decades.

Over the past four years, I have worked exclusively as an Independent Medicolegal Expert. I no longer treat patients, and my skills and expertise are put to assessing people to determine if they have suffered a psychiatric illness as a result of an injury, and as such the subject of a claim for compensation. The words in my title are crucial. Although I receive referrals from legal practitioners, I maintain independence as stipulated by law, with my medical experience and expertise being used to inform the relevant parties when deciding on outcomes. 

So my day today work involves assessing what are referred to as “examinees”, scrutinise documents provided, and writing reports that address the questions a legal practitioner poses to me. 

My love of written communication is especially valuable here, and I have the opportunity to combine my talents and skills in that area with my role to provide opinions that serve a legal process.

I have noticed similarities with running a private psychiatry practice, especially that there is the art of what I do and then the practical aspects of running a business. There is the risk of working in a solo practice, leading to feelings of isolation, such as when private practitioners choose this setting over a group practice. But I do find the ability to choose my hours and my terms of engagement with legal practitioners well worth this. This new career direction actually delivers work life balance and an ability to switch off and pursue other interests. 

Medicolegal practice affords clinicians the ability to set fees in a way that they may not have been able to in the past. There is no Medicare arrangement, and invoices are sent directly to the legal practitioners who engage us. We don’t release reports until they are paid for, and we can do something else foreign to clinical practice - we can set fees that adequately remunerate us for all of our work around a matter, not just the time spent examining the legal practitioner’s client. For example, we can charge for time to peruse larger files or set a rush fee for an urgent report. We can also increase fees that align with real practice cost rises, rather than absorb and work with less margin.

Medicolegal practice can be more lucrative than clinical practice, but it is not all about the money. For me, it’s about the recognition that we are indeed experts in our clinical specialties, and our clients value that. In medicine, there are very few areas left where we can feel well regarded, as if our opinions and our experience actually matter. 

The field is not without its drawbacks. For some, losing long term continuity of care is a negative. Combining clinical practice with medicolegal work addresses that dilemma for those wanting that aspect to their work. For others the continuity of care and the responsibility is something they would rather trade for brief and more intense work that can be handed back to a referrer. 

And then there is the other component to the work - giving evidence and defending your report in Court. Some enjoy that challenge, others find it the most stressful part. What I have come to learn over time is that how things go at court begin the moment you begin to prepare the report and with sound attention to detail, being thorough and answering all questions posed to the best of your ability and expertise minimise most of the potential concerns about being in the witness box. Joining medicolegal societies helps a lot here too, learning what lawyers want and as much as you can attending and upskilling about all matters legal are great strategies to truly inform your role. 

It is also pleasing to find an area of medicine that continues to challenge and stretch me, and keeps me fresh and interested in a way that clinical medicine stopped doing.

So when setting out, or merely asking more questions about medicolegal practice, ask widely and ensure you examine all the moving parts that shape your work and your practice. Being prepared and set up correctly at the start bodes well for a successful and rewarding aspect to your new career direction. 

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Dr Helen Schultz is a Psychiatrist IME with years of experience educating and training psychiatrists, now running face-to-face practical workshops for those looking to transition into medicolegal psychiatry practice — and accepting referrals for medicolegal reports across Australia in personal injury matters, including third party, medical negligence and historical abuse claims. Register for the next Sydney workshop at www.drhelenschultz.com.au/workshopor book via hello@drheelnschultz.com.au.