“Once upon a time there was a Consultant Ophthalmologist. He loved his work and all the challenges of patient care. When he became part-time in the NHS, he decided to add to his skills and started doing medicolegal work, after proper training of course.”

As this aspect of my work developed, I found the intellectual challenges and rigour of medicolegal work gave me great job-satisfaction, and I allocated more of my time to it. Eventually I almost hit the VAT threshold, and decided to spin-off the medicolegal work into a new company, which now trades as EYE-LAW CHAMBERS®. Ophthalmology is very sub-specialised (so an expert may cover retina but not eye-lids), and there was the idea to setting up a virtual Chambers to cover all aspects. We developed a comprehensive terms of business which includes payment before release of reports or alternatively, a fee uplift if invoice and report are released simultaneously. This has proved very successful with virtually no aged debt. In return, we offer a Service Standard of report delivery in 4 weeks which is very popular with solicitors as it allows them to avoid agencies whose job is to chase experts.

There were some problems; getting paid being number one. I also experienced a solicitor converting my report from a PDF to WORD so that she could edit it to what she wanted me to write! I had a very interesting conversation with the senior partner about that. It became clear that this niche of eye- and vision- related claims was quite busy, with few real experts: some seemed not to understand the duty not to be partisan, and at least one produces a PhD thesis for every report.

We only accept as Experts those in active clinical practice, not any-one doing only medicolegal work in retirement. We also expect to see evidence of medicolegal training for new members. We have grown from a single Expert to a group of 12 (more pending) covering virtually all aspects of ophthalmology, as well as an Expert in Optometry whose expertise dovetails with our own. As such, if a case requires expertise that one expert cannot provide, we can usually suggest another Expert in Chambers and keep the work “in house”.

I have been pleasantly surprised at the growth of about 15% a year. Not all has been perfect: Experts come and go, and solicitors continue to try to avoid payment: we take one or two a year to Court and have yet to lose a case.

As Head of Chambers (managing director) I review all requests for Experts and check they are directed to one of our members with an appropriate expertise. I have to get our terms of business agreed – solicitors love to try forms of words which they can later say was not their acceptance! The case then goes to the Expert who does the work and then invoices Chambers and we invoice the solicitor. What it means is that the Expert only does the Expert work: Chambers does the initial case review and acceptance, and then the invoicing and chasing for payment; this frees up a lot of time for Experts and has proved very attractive.

My typical day involves starting with Chambers’ admin: emails and occasional telephone calls, then a mixture of my own medicolegal cases and seeing patients. Has my medicolegal work changed my patient care? In some ways, yes. Documenting consent and discussions in more detail are an obvious aspect. However I’ve also had lots of colleagues come for informal discussions about unhappy patients and how to manage them, and any complaints. It is a sad fact that most patients don’t understand risk (which only happens to other people) and conclude that any complication or undesirable outcome must be negligence.