Hindsight bias in medicolegal expert reports

To the Editor: It is possible to diminish bias, especially in litigation concerning general practitioners.1 First, request all the defendant's clinical notes about the patient, not merely the records of the incident. Then, before reading the allegations or the history following the incident, read the entire history of the patient's contacts with the doctor or the practice: frequency of attendances, nature of complaints, details of history and examination, referrals for tests or second opinions — all give insight into the nature of that patient–doctor relationship.

Reading the notes from the beginning allows the expert to approach, anterospectively, the consultation(s) at which things went awry. If the relevant consultation cannot be identified, the expert has to correlate the patient's story, as presented by the solicitor, with the doctor's records.

As he or she progresses through the records, the expert can assess whether or not the doctor's recorded acts accorded with responsible practice. Unrecorded omissions can also be identified, based on what is written in the records: why didn't the doctor ask about X, examine for Y, request a test for Z or refer to a specialist? Of course, these things might have been done, but not recorded.

One would hope that barristers for both parties would frame their questions based on a similarly anterospective approach, and that judges would focus their attention and that of a jury (if there is one) on the appropriateness of process rather than on the unfortunate outcome.

I cannot conclude without mentioning one solicitor's claim that the doctor had failed to use a retrospectoscope.