Working as a medico-legal adviser

Drs Samantha Bell, Edward Farnan and Sissy Frank explain how they became medico-legal advisers with the MDU and what the role involves day to day.

Left to right: MDU medico-legal advisers Dr Samantha Bell, Dr Edward Farnan and Dr Sissy Frank (Photos: MDU)

What is a medico-legal adviser?

Dr Samantha Bell: Medico-legal medicine is often described as the interface between medicine and the law. Medico-legal advisers (MLAs) at the MDU are all experienced doctors with knowledge of legal medicine. As part of the MDU advisory department, MLAs offer guidance and support to MDU members when they face medico-legal issues. These may include ethical dilemmas, complaints, acting as a professional witness and dealing with regulatory and disciplinary matters.

Dr Edward Farnan: An MLA provides ethical and legal advice and assistance to doctors, mostly in matters which arise out of the clinical care of patients. This includes assisting doctors in responding to complaints, prior to attending court, and in GMC fitness to practise investigations.

What is your medical background?

EF: I was a GP for around 15 years, the last 11 of these as a GP partner in a large practice in Northern Ireland.

SB: Before becoming an MLA I had over 20 years’ experience in clinical medicine as a doctor in both hospitals and general practice and was, and still am, a member of two royal colleges – the Royal College of Physicians and the RCGP.

Dr Sissy Frank: Initially, I completed my medical and legal qualifications in the USA. However, I did re-train in the NHS and worked within the NHS in a variety of roles for a number of years before becoming an MLA.

Why did you decide to become an MLA?

SB: As a clinician I became increasingly interested in the relationship between medicine and the law - ever mindful of how easily a simple error could potentially lead to a catastrophic outcome. I was fortunate in that, whilst working as a GP principal, I was able to develop a portfolio career. This included undertaking some medico-legal work and work as a medical member of the first-tier tribunal for the Ministry of Justice.

I also simultaneously worked towards a master of laws (LLM), in healthcare ethics and law, from the University of Manchester. Eventually I decided that I would like to embark on a full-time career in legal medicine and have been working for the MDU, as a medico-legal adviser, since 2015.

EF: I was the clinical governance lead for the practice. I was also a member of a research ethics committee and had completed a masters degree in medical law. This seemed to be the next logical step to expand on my interests in the area.

SF: I have always been interested in the interplay between law and medicine. Being an MLA allows me to consider the broader issues raised within medical practice. 

Did you have to undertake any further training to become an MLA? 

EF: Yes. The MDU has an in-house training programme for new MLAs, which won a Princess Royal Training Award in 2017. This includes an intensive period of ‘on the job’ training in our London office and, since we are all home-workers, a further extended period of remote supervision with an individual trainer. Like any job in medicine, the learning never really stops.

What are the most important personal qualities to be a MLA? 

SB: It is important not simply just to have an interest in legal medicine but a passion to offer support to those colleagues who find themselves facing situations which can at times be very stressful. Good communication skills and empathy are certainly on the list. The work is busy and at times challenging and it is important to be hard working, highly motivated and self-disciplined.

EF: Like GPs, MLAs need to be able to process a large of amount of information quickly, while still paying attention to detail. An ability to multi-task, and to prioritise work is also common to both roles. Perhaps most importantly, it is important to be able to work as part of a team, and to be a good and empathetic communicator.

SF: It is vital to have excellent written and verbal communication skills, as the issues you are dealing with can sometimes be quite emotive and subtle. So it is important both to listen well to the information you are being given and the concerns being expressed, and to convey your own thoughts clearly. 

Most important, however, is a sense of empathy, an ability to appreciate and to some extent share in someone’s feelings, to put yourself in their position and understand their frame of reference. 

What does a typical day look like in this role?

EF: There’s no such thing – also a bit like being a GP! The core work involves taking calls on our 24-hour medico-legal helpline and dealing with written file work – both new and long-running cases. In addition there can be conferences with solicitors and barristers, or lectures to clinicians as well as writing articles and working with other departments in the MDU.

SB: A typical day is busy, I expect to receive new cases every day. These may include advising members when they receive a complaint or a request for a statement for example, if they have been involved in a serious untoward incident (SUI) or care of a patient referred to the Coroner.

Occasionally members request advice and assistance related to regulatory matters, for example they may have been notified that the GMC is opening an investigation and considering their fitness to practice. This can be extremely stressful for our members who often require a considerable amount of support. I listen to their concerns and offer support and advice throughout the process.

What do you most enjoy, and are the any downsides, to being an MLA? 

SF: I like discussing ethical or legal issues or practical concerns around relevant topics like consent, capacity and confidentiality, and helping people solve sometimes seemingly intractable dilemmas. I find it immensely rewarding to help fellow professionals who may be upset, frustrated or distressed and to provide guidance or assistance that may make their jobs somewhat easier. 

Being a medico-legal adviser is a great job, and one that provides great opportunities and rewards for someone interested in examining the larger questions and overarching principles that guide medical practice.

EF: Supporting doctors who find themselves subject to investigation and who fear that their careers and livelihoods are in jeopardy, and supporting them from the earliest stages of an investigation to a good outcome is tremendously rewarding. Being a home worker could feel isolating at times, but this is offset by being part of a great team and we do have plenty of face-to-face contacts with members and colleagues alike.

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