To the Editor: I read with interest the recent article by Hugh and Tracy on hindsight bias in medicolegal expert reports.1 As they themselves admit, "the very seeking of an expert opinion usually indicates that there has been an adverse outcome". In my experience, the unfortunate outcome can usually be predicted within reading the first few paragraphs of the brief. I do not think withholding information on outcome would prevent the occasional use of the "retrospectoscope".

I wondered whether the views of the authors might have been slightly biased on the basis of the particular cases they had reviewed as Chairmen of the Australian Cases Committee of the Medical Defence Union. Did these cases range across all specialties and subspecialties?

The problem of hindsight bias is, in my view, greater when there are no clearly accepted guidelines for diagnosis and management, or where the case is unusual and falls outside the exposure of experienced clinicians.

They mention clinical practice guidelines as a way to improve the objectivity of experts, but then seem to exclude them on the basis of the expense and time involved in their development.

In cardiology, there are now internationally accepted guidelines developed by the American College of Cardiology and the American Heart Association for the diagnosis and management of all common clinical situations.2 These are regularly updated and have been sometimes modified for Australian use by the Quality of Health Care Committee of the National Health and Medical Research Council (NHMRC) or the Cardiac Society of Australia and New Zealand.3 These guidelines provide an important baseline for any expert opinion in this specialty.

More universal clinical guidelines will educate reviewers. It will reduce the problems of hindsight and the overzealous expert. It will also allow the expert to be tested by the well-prepared barrister. Human nature being fallible, it will not eliminate personal bias.