Disagreement among experts
These days, medical treatment is not as specialised as one might think, as Professor Geir Hoff and others have pointed out (1). Guidelines such as regulations on patient records, guides, structured pathways and the like often govern patient treatment. Most doctors can therefore easily assess whether good medical practice has been followed, also in specialties other than their own. For this reason, a surgeon can assess whether the GP has assessed the patient well enough and referred him/her for further treatment at a sufficiently early stage; the surgeon can also assess whether the anaesthetist was in full control of the patient's blood pressure and oxygen saturation during the operation, to mention a few examples.
Several studies have shown that violations of general medical treatment procedures and standard guidelines are often the cause of incorrect medical treatment (2, 3). If these deviations are not pointed out, it may mean that patients do not receive the compensation they are entitled to, or that they only receive compensation after going to court where other experts can contribute to the assessment.
In Case 2013/01876 I found several clear deviations in the treatment that the specialist had overlooked. Since I was not formally qualified to assess this, my immediate manager and the specialist asked me to change my statement as regards these points, which I was unable to do for reasons of professional ethics. However, in another case where there was similar disagreement, the expert without formal specialty qualifications was forced to back down. As a result, the statement did not describe the medical disagreement between the experts, and consequently the patient was not informed about this.
Another case (2007/01186) related to a serious treatment injury illustrates the fact that assessments by other colleagues without formal qualifications may be of crucial importance. Both the Norwegian System of Patient Injury Compensation and the Patients' Injury Compensation Board rejected the complaint on the basis of the expert assessment of specialists in two different specialties. Since the Board was summoned to appear in court, a lawyer asked me to evaluate the case as an expert witness for the patient. As a paediatrician, I discovered material and serious errors in the treatment pathway in both these specialties. When the Board became aware of my statement via the pleading to the court, it was decided to re-examine the case, and the notice of proceedings was withdrawn.
These cases underline that a generally competent medical specialist is clearly capable of evaluating the course of treatment in other specialties. Such assessments can also counteract the herd mentality that is still rife in many specialties of (preferably) not criticising colleagues. Therefore it is difficult to understand why the Norwegian System of Patient Injury Compensation stubbornly clings to this silo mentality as regards competence – this has no place in modern medicine.