From treating dry eyes and eye strain, to reporting on complex eye related injuries in court, our next thought leader is a medico-legal professional with an array of expertise in the medical sector.
Professor Charles Claoué, a Consultant Ophthalmologist here discusses the problems in private healthcare insurance, what happens when legal and medical matters intertwine, and how the general awareness of solutions available could be improved on. Charles also delves into the experiences that brought him to the reputable position he now holds, and gives Lawyer Monthly an outlook on the proactive attitude necessary to be a thought leader in this field.
Are there any particular medical matters that often arise in your work from patients in the business and financial sectors?
My patients tend to have problems related to their environment, so they have a lot of dry-eye problems because they tend to work in air conditioned offices and it is a screen heavy environment. They often suffer from eye strain related to screens that are too bright, too contrasted or just at the wrong distance.
And what are the solutions you provide for those problems?
The solutions are often to just to have a bowl of water in the corner of the office to increase the humidity and the judicious use of artificial tears and advice on appropriate contrast and brightness of screens and appropriate working distance. There’s the misbelief that having screens very close helps and in fact it is much more tiring to have it too close and often just moving the screen to arm’s length makes a big difference.
Do you think many of these people who come to you with these issues were previously aware that was the problem behind it?
No, usually not. For me, it is obvious, but it is specialist knowledge. No doubt what they do, I wouldn’t understand either.
As a specialist in ophthalmology, what are the legal considerations you must make day to day, to cover you and your team?
The first thing is, are you giving the patient the right treatment? In other words, would other surgeons offer, broadly speaking, the same treatment? The second thing is, does the patient have an adequate understanding of what is proposed, in order to give consent. And thirdly, you must take appropriate care to minimise the risks associated with surgery.
What might those be?
It is very difficult as you operate as part of a team, but as much as possible you want to make sure that no solutions or drugs are changed for reasons of cost, without being sure that there is no compromise of safety.
How do you make everyone is fully aware of possible changes?
There are protocols and guidelines and it should be known that nothing should be changed without it being considered by the doctor involved in the case.
How often are those considerations ignored?
It happens occasionally and usually it makes no difference, but if something is changed without reference to the doctor, it can result in a medico-legal case which is difficult to defend, as the doctor takes final responsibility.
Are there any further legal considerations to make in relation to children you work with?
I don’t work with children, but in the profession in general the problem with children is consent. There is a grey area where children can express their feelings and this, in the family court, it is called Gillick competence. If a child is of age to be Gillick competent and you do not take their opinion into consideration, then you can be in trouble even if the parents have given consent.
Are your patients always aware of the legal matters involved in their medical matters?
Patients are often not aware of the legal matters involved in their medical care and they are usually not aware that there is a simple contract for the provision of medical services for which they have financial liability.
Patients that are victim to this are those who have private healthcare insurance, as they think they are absolved from any financial liability. The industry has changed and become more aggressive about the profits from an insurance business. Therefore, insurance companies have tried to reduce payments to doctors for the provisional medical services, and as an example, most companies will only pay doctors one third of what they paid twenty years ago for cataract surgery, despite it becoming a more complex procedure with much higher patient expectations.
What has been the response from your field?
Most senior consultants have decided to detach themselves from insured patients and so, many insured patients cannot find senior consultants to provide services and have not usually been informed by the insurance company, when their contract between the patient and the company was incepted.
So how would you advise, especially people in the business and finance sectors, to be aware of these procedures?
Well I think that is very difficult as they are usually in group policies. What I do with all insured patients is sit them down at their first consultation and explain that they are likely to face a shortfall and they will be liable for this amount. For twenty years, I have had them sign a term of business, in which this is made clear in simple English language. Nevertheless, this is a recurrent problem that patients think that as they are insured they have no legal liability.
Are there any changes you would like to see happen, in terms of how those procedures are performed?
Insurance companies need to make it clear to clients that despite having insurance they may still face a shortfall. This would make it much more analogous to motor insurance, where insurers already state that if you go to these garages you won’t have to pay anything, but going to another garage may result in charges; as far as I am aware that has not damaged the motor industry insurance and I cannot see any reason to why it would damage private health care insurance.
Why do you believe you are a Thought Leader in this field?
The first thing, as I have always told my trainees, that I am an “average surgeon”. The reason for this is that as soon as you believe you are above average, you stop learning. If you believe you are average you will always be trying to improve, and as such you will be up-to-date and trying to do better with every medico-legal report. Until I stop practising I will be an average expert, but always hoping to do better.
As a member of the Academy of Experts, what have your experiences taught you to learn and expand professionally? How do you believe your expertise in medicine can still be furthered?
Over the years I have learnt to be much more critical of my report and try to look at them perhaps as the judge would look at them. I try very hard not to stray out of my area of expertise; I try to answer the questions that are asked of me, but not to volunteer opinions unless I think they are important for the judge to hear.
It is true that you never stop learning in medicine; you should be going to regular teaching lessons, you need to go to national society meetings and probably supranational society meetings on a regular basis in order to be always learning something new.
Do you have a mantra or motto you live by when it comes to helping your clients?
I have two: the first is Theodore Roosevelt’s ‘The Man in the Arena’:
“It is not the critic who counts, not the man who points out how the strong man stumbled, or where the doer of deeds could have done them better. The credit belongs to the man who is actually in the arena; whose face is marred by dust and sweat and blood; who strives valiantly; who errs and comes short again and again; who knows the great enthusiasms, the great devotions, and spends himself in a worthy cause; who, at the best, knows in the end the triumph of high achievement; and who, at worst, if he fails, at least fails while daring greatly, so that his place shall never be with those cold and timid souls who know neither victory nor defeat.”
The second is from Calvin Coolidge:
“Nothing in the world can take the place of persistence.
Talent will not; nothing is more common that unsuccessful men with talent.
Genius will not; unrewarded genius is almost a proverb.
Education will not; the world is full of educated derelicts.
Persistence and determination are omnipotent.”
The slogan “press on” has solved and will always solve the problems of the human race.
What three qualities do you think make a thought leader, and let’s look at this from a medical perspective?
Undoubtedly, intelligence has to be one of the three qualities. I think having a maverick personality, is probably the second one; and thirdly, luck!
How do you measure your professional success?
My first measure is the gratitude of my patients. The second is the recognition by my peers in medicine. Thirdly there is the gratitude and recognition from my colleagues in the legal profession. And of course, without the love and support of my family, nothing would be possible.
