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90 Medico-Legal J. 3 (2022)

handle is hein.journals/medlgjr90 and id is 1 raw text is: Medico-Legal Editorial Journal Editorial: Limiting liability for a second opinion - where does the buck stop? Jane Turner writes Multidisciplinary team (MDT) decision making is well established in cancer care leading to more robust deci- sion making and is the norm. The medico-legal impli- cations have been previously examined, individual members of the team taking a shared legal responsibil- ity which means sometimes they are unaware of their individual risk of being found negligent.1 The cost of multidisciplinary meetings for cancer has been previously considered at the Royal Marsden in 2013.2 At the time, the costs were in the region of £415 per new patient and a median of £5136 per month (without considering additional costs). In more detailed cost analysis for the larger MDTs, taking preparation time into consideration, this ranged from £14,430 (gynaecology) to £38,327 (breast) per month. They estimated that their institu- tion might be spending £2,745,082 a year on multidis- ciplinary meetings and concluded that discussions were needed on how to streamline the MDT process and make it as efficient as possible with ever-reducing NHS resources. Patients are entitled to a second opinion. As some oncological cases are unusual they are referred by other hospitals' MDTs to more specialist (tertiary or quater- nary) units for opinion. A delicate balance is required: to be thorough but avoid unnecessary duplication. The problem comes where a specialist unit is asked for a second opinion and sent an entire set of irrelevant or historical images with little focus to the relevant ques- tion. A typical MDT meeting has multiple patients to discuss within limited time and even more limited prep- aration time. Insisting that all images come across with reports, or taking time to look at them all, could add countless hours which would not normally benefit the patient unless something unexpected was found. Specialist units are more likely to receive referrals for second opinion MDTs and therefore have this addi- tional cost. It is important that time is not wasted double report- ing images following such poor referrals. However, hospital trusts must protect themselves and their team members from negligence as well as being sensible with resources. Probably the best solution is that a second Medico-Legal Journal 2022, Vol. 90(1) 3-4 © The Author(s) 2022 Article reuse guidelines: sagepub.com/journals-permissions DOI: 10.1 177/00258172221078347 journals.sagepub.com/home/mlj $SAGE opinion MDT should clarify the exact question being asked prior to the referral being accepted. Similarly, they need explicitly to define the limitations of their advice by stating that they have only considered that particular question and examined only particular images or reports. Jane Turner Medical Editor Diana Brahams writes In my practice at the Bar, I occasionally received a bundle of documents from solicitors with the request to advise generally. This suggested the solicitor who was making the referral (a) didn't know how to pro- ceed, (b) was reluctant to or was unable to give suffi- cient time to deal properly with the matter, (c) had a lack of expertise and skill, (d) wished to pass the buck for what needed to be done elsewhere, or (e) had a combination of all or some of these qualities. It is, as will be the case in other professions, usually more appropriate to specify what issues are to be given more specialist attention and most solicitors will raise a list of questions they believe to be relevant and per- tinent and suggest a course of action for approval or further discussion. But to cover their own backs, even the most skilful and experienced of solicitors will usu- ally add a final request: Counsel is also asked to advise on any other issue she considers to be relevant. A request that is broad enough to cover anything that may have been missed by the solicitor and which will pass the risk of this happening to counsel. This may be on some tactic but may also include the real danger of expiring time limits for a course of action. It aims to pass the buck from solicitor to counsel. If we extrapolate from this and take by way of anal- ogy a patient who is referred by a GP to a specialist either as an individual practitioner or to a hospital department, the outcome for the patient may depend on the request that accompanies his referral. The GP's letter may simply record the patient's stated symptoms and ask for advice (as in counsel is asked to advise generally). Or it may be a letter that requests