At Index Medicolegal we assist the legal profession resolve personal injury and medical negligence proceedings through the provision of authoritative, balanced, and Courtworthy independent Expert opinions:
We have shown that a report commissioned from a Pain Medicine Physicians can bridge the gap seen to exist between physical and psychological components of pain and suffering in the opinions of other Experts.
To this day, assessing causation and quantum of pain and suffering is still amongst the most frequent requests solicitors and case managers make to our panel of Expert clinicians.
Our Pain Medicine Physicians provide independent Expert opinion on matters of causation, condition and prognosis across personal injury, medical negligence, and permanent disability claims.
Pain Medicine Physicians are identified by their post nominals FFPMANZCA (or similar) and most hold fellowships in a primary speciality in addition to Pain Medicine. Upon Index Medicolegal’s panel of pain medicine physicians, we have a range of subspecialist fields of pain medicine represented, such as pelvic pain, pain in children, pain interventions, cancer related pain, narcotic, and medicinal cannabis prescribing.
Our Pain Medicine Experts have an intimate knowledge of the physiology, psychology, pharmacology, and pathology of pain coupled with an operational knowledge of hospitals and other healthcare facilities. They are usually the clinical leaders in Multidisciplinary Pain Management Programmes and are aware of diagnostic procedures, surgical techniques, postoperative care, and general medical issues. As a result of their extensive and multifaceted clinical experience, they have the ability to critically analyse conflicting data and opinions relating to the aforementioned areas, thereby delivering a robust and balanced Expert opinion.
Pain Medicine Physicians may perform interventional and diagnostic procedures for pain and can advise on patient selection for these procedures and are the appropriate Experts for patient selection, screening, and implantation of invasive and advanced forms of pain relief such as neuromodulation (spinal cord stimulation) and intrathecal drug delivery.
Chronic Non-Malignant Painful Conditions e.g. Complex Regional Pain Syndrome, Painful Neuropathies, Neuropathic Pain and Nerve Entrapment Syndromes using a combination of drug and interventional treatments.
Spinal Pain not amenable to surgery such as Failed Back Surgery Syndrome, Arachnoiditis, and Degenerative Spinal conditions using several treatment modalities including drug treatments, injection techniques, radiofrequency nerve ablation and “advanced” pain therapies such as Spinal Cord Stimulation and Intrathecal Drug Therapy
Pain Syndromes in which an individual’s pain is disproportionate to their physical condition by determining the contribution of physical (organic) and psychological (non-organic) components to suffering.
Multidisciplinary Pain Management teams of allied health professionals in Pain Management Programmes in which Cognitive Behavioural Therapy is used to treat individuals with pain better self-manage their condition
Anaesthetists are the largest single group of hospital clinicians who will encounter 1 in every 5 patients admitted to hospital. They work across all areas of hospital activity including operating theatres, delivering on acute pain services and critical care units. As a result they are highly capable of providing opinion on hospital and system standards of care and system-based failures (root cause analysis).
Anaesthetists possess specific skills in airway management, intravenous access, epidurals, and neural blockade. Specialist anaesthetists are often asked to provide an opinion or a report when an individual undergoing a hospital procedure has suffered an adverse event. Common reasons that they may be asked to provide an Expert opinion include perioperative management of patient medications, assessing risk for surgery, nerve injury, awareness during surgery and dental damage. Because patients undergoing anaesthesia have close monitoring of their vital signs, an initial review of the anaesthesia record can often provide a useful guide as to whether an event was avoidable or not.
Anaesthetists conduct anaesthesia using a variety of techniques that include general anaesthesia, sedation (twilight, neurolept), or regional anaesthesia, for example spinal and epidural anaesthesia.
Because anaesthesia is a large clinical discipline and several subspeciality areas such as paediatric anaesthesia, obstetric anaesthesia and cardiac anaesthesia exist, it is important when instructing an anaesthetist to ensure that their current clinical practice is appropriate for the case in question.
Psychiatrists specialise in the assessment, diagnosis, and treatment of psychological conditions or serious psychiatric illnesses including anxiety, trauma-spectrum disorders and psychotic disorders especially where there are diagnostic challenges, suicidal ideas, other risks or where there is suboptimal response to standard treatment by general practitioners or psychologists.
A psychiatrist is skilled in undertaking a comprehensive psychiatric assessment to arrive at an accurate diagnosis and formulation that considers the interaction between physical and mental illness and the unique needs and attributes of the individual patient. On this foundation a psychiatrist develops a comprehensive treatment plan and provides shorter or long-term care depending on the needs of the patient.
In addition to being able to causally link and quantify psychiatric conditions (e.g. post-traumatic stress disorder or depression) to a specific event such as a workplace or motor vehicle accident, Psychiatrists can usefully provide opinions where there may be a psychological contributions to seemingly unrelated physical condition such as pain, disability and addiction.
Psychiatrists may practice in a number of subspeciality areas such as child and adolescent psychiatry, addiction medicine, forensic psychiatry, family therapy or neuropsychiatry. Psychiatrists work in a variety of settings including the acute in-patient setting, outpatients and community-based settings. They work closely with their general practitioners and medical specialists.
Psychiatrists are also able to recommend and provide a range of treatments including psychological treatments, medication, and brain stimulation therapies, such as electroconvulsive therapy and provide advice on lifestyle and interpersonal difficulties. Psychiatrists treat all types of mental illness, emotional disturbance, and abnormal behaviour from mild or episodic conditions to those that are severe, persistent and life threatening and work with people of all ages and from all ethnicities and backgrounds
At its core, psychiatry involves listening carefully and sensitively to people’s most personal thoughts and feelings, understanding their mental state, and working with them to identify and implement appropriate treatments including psychotherapy, psychotropic medication, social strategies and other interventions
They are also well placed to manage patients with occupational or sports-related musculoskeletal or neuromuscular injuries
Rehabilitation medicine physicians manage inpatients, outpatients, and community patients with medical, musculoskeletal, neurological, and neuromuscular disorders, with an emphasis on maximising functional ability and quality of life. Patients treated by rehabilitation physicians are those affected by function limiting and/or painful conditions involving the central, peripheral and autonomic nervous systems, the cardiopulmonary system and the musculoskeletal system, as well as those who experience disability due to illness or injury affecting other body systems.
The rehabilitation medicine physician is an ideal treating or consulting physician for patients who have impaired function due to debility and deconditioning including older patients and those with reduced function, because of chronic diseases or other complex health conditions.
Rehabilitation medicine physicians are specially trained in the use of therapeutic exercise, orthotics, prosthetics and other rehabilitation equipment and modalities. They are therefore able to prescribe these precisely to meet the patient’s specific needs.
Index Medicolegal is somewhat unusual in that upon its panel of Experts it boasts paediatric and adolescent pain physicians, paediatric anaesthetists, paediatric rehabilitation, paediatric orthopaedics, and paediatric gastroenterology. Independent reports from Experts in other paediatric fields of medicine can also be arranged upon specific request.
Gastroenterologists are specialist physicians who treat conditions affecting the digestive system including oesophagus, stomach, bowel, pancreas and liver. Gastroenterologists perform examinations and procedures on the digestive organs including endoscopy, ERCP (endoscopic retrograde cholangio pancreatography, colonoscopy and polypectomy.
The discipline of maternal-foetal medicine includes preconception care, specialized prenatal
care and intrapartum care, obstetric and medical complications of pregnancy, diagnosis and management of foetal anomalies, foetal complications, and foetal testing. A maternal-foetal medicine (MFM) specialist has advanced knowledge of the medical, surgical, obstetrical, foetal, and genetic complications of pregnancy and their effects on both the mother and foetus. MFM specialists are complementary to obstetric care providers in providing consultations, co-management, or transfer of care for complicated patients before, during, and after pregnancy. MFM specialists are skilled at performing detailed ultrasound examinations of the unborn child in order to determine the health of the unborn child and to assess foetal well-being for congenital abnormalities and disabilities occurring after delivery.
Endocrinologists are specialist physicians who treat diseases of the hormone producing glands- pancreas, thyroid, pituitary, ovary and testes. Endocrinologists commonly manage patients with diabetes, underactive and overactive thyroid glands, hormonal growth abnormalities such as growth retardation, acromegaly and abnormalities in sex hormone production.
Medical Oncologists are specialist physicians who have undergone special training in diagnosing and treating cancer in adults using chemotherapy, hormonal therapy, biological therapy, and other targeted therapy. A medical oncologist often is the main health care provider for someone who has cancer. Medical oncologists often work in multidisciplinary teams of surgeons, radiotherapists and palliative care physicians..
Geriatricians (Gerontologists) are specialist physicians who specialise in the care of the elderly. Geriatricians undertake medical management of diseases of the elderly including assessment of home care and rehabilitation needs. They are often the clinical leads in multidisciplinary assessment of elderly patients. Geriatricians are skilled at determining the cognitive and physical capacities of the elderly and often are asked to comment upon the cognitive competences of an elderly person with intercurrent disease.
Respiratory medicine specialists are physicians who have expertise in the assessment and treatment of the respiratory system and chest. Conditions that respiratory medicine specialists treat include asthma, smoking related lung disease, lung disease from exposure to dust and particulate matter, such as asbestos related lung diseases and silicosis. Respiratory physicians undertake direct examinations of the lungs by performing bronchoscopy and lung biopsy.
Neurologists are medical specialists who have undergone special training in understanding the function, dysfunction and treatment of the nervous system Neurological diseases often lead to a great deal of dysfunction and disability through diseases of the nervous system itself such as epilepsy, multiple sclerosis, Parkinson’s disease. But in some cases, the neurological injury can be the result of non-neurological disease such as poisonings, trauma, and congenital abnormalities.
A Urologist is a surgeon who specialises in the surgical treatment of the male and female urinary tract including the kidneys and bladder. Urologists treat benign diseases of the urinary tract such as kidney stones (calculi) and recurrent infections as well as cancerous conditions such as prostate, bladder and renal cancers.
Upper gastrointestinal (GI) surgery is surgery performed to treat pathologies of either the upper gastrointestinal tract (small bowel), gall bladder, liver, pancreas, or oesophagus. The upper gastrointestinal (GI) includes the oesophagus (the food pipe), the duodenum (the first part of the small intestine) and stomach. Upper gastrointestinal surgery is often performed either entirely by a keyhole technique or by keyhole surgery assisted by open surgery.
Bariatric surgery is surgery performed on the stomach or intestines to help a person with extreme obesity lose weight. Bariatric surgery is an option for people who have a high body mass index and is for people with an elevated body mass index who have health problems such as type 2 diabetes or heart disease.
There are two basic types of bariatric surgery — restrictive surgeries and malabsorptive/restrictive surgeries. Restrictive surgeries work by physically restricting the size of the stomach and slowing down digestion. Malabsorptive/restrictive surgeries are more invasive surgeries that, in addition to restricting the size of the stomach, they physically remove parts of the digestive tract, interfering with absorption of calories. An example of restrictive surgery is adjustable gastric banding also called lap band surgery. Stomach banding is the process of placing a synthetic band around the upper portion of the stomach. It works by creating a small “pouch” at the top of the stomach just below the oesophagus, thus dramatically reducing the amount of food that can be eaten. The size of the opening to the stomach determines the amount of food that can be eaten. The size of the opening can be controlled by the surgeon by inflating or deflating the band through a port that is implanted beneath the skin on the abdomen. The band can be removed at any time.
Another restrictive surgery is the sleeve gastrectomy. This procedure generates weight loss solely through gastric restriction (reduced stomach volume). The stomach is restricted by stapling and dividing it vertically and removing more than 85% of it. The stomach that remains is a narrow tube or sleeve, which connects to the intestines. The restricts the amount of food the stomach can hold, as well as removing the portion of the stomach that generates Ghrelin, the hormone that causes hunger. The procedure permanently reduces the size of the stomach. The procedure is performed laparoscopically and is not reversible.
General surgery is a surgical specialty that focuses on abdominal contents including oesophagus, stomach, small intestine, large intestine, liver, pancreas, gallbladder, appendix and bile ducts, and often the thyroid gland (depending on local referral patterns).
General surgeons work as part of trauma teams and are therefore useful in treating patients needing surgical treatment arising from accidents causing multi trauma.
A Breast and Endocrine surgeon are a specialist surgeon who has undergone further training in the surgical treatment of malignant and benign conditions of the breasts and thyroid gland in both males and females. Breast and Endocrine surgeons undertake surgical treatment of breast and thyroid cancers including mastectomy and prophylactic mastectomy, breast reduction, enlargement, and reconstruction.
Vascular surgeons are specialist surgeons who specialise in the surgical treatment of diseases affecting the arteries and veins. Commonly performed operations undertaken by vascular surgeons include varicose vein surgery, aortic aneurysm surgery, surgery on the blood vessels supplying the brain thereby preventing stroke and amputations of limbs with inadequate blood supply. Increasingly vascular surgeons are performing operations using minimally invasive techniques sometimes referred to as endovascular surgery.
Plastic and reconstructive surgery involves the treatment of diverse injuries but with a special emphasis being placed upon reconstruction and repair. Plastic and reconstructive surgeons treat the following types of problems: repair of soft tissue wounds, burns, facial fractures, hand injuries, tumour excision and repair of congenital tissue anomalies
Orthopaedic surgery is the branch of surgery concerned with conditions involving the musculoskeletal system. Orthopaedic surgeons use both surgical and nonsurgical means to treat musculoskeletal trauma, spine diseases, sports injuries, degenerative diseases, infections, tumours, and congenital disorders.
Cardiac surgeons are specialist surgeons who undertake surgery on the heart and blood vessels around the heart. Examples of operations commonly undertaken by cardiac surgeon include coronary artery bypass grafting, heart valve replacement and surgery on the aorta.
Oral and Maxillofacial surgeons are qualified dentists as well as specialist surgeons. Oral and maxillofacial surgeons treat begin and malignant conditions affecting the teeth, jaw, oral cavity, and neck.
Spinal surgeons comprise both orthopaedic surgeons and neurosurgeons who specialise in the surgical treatment of benign diseases of the vertebral column. Examples of operations commonly undertaken by spinal surgeons include discectomy, disc replacement and spinal fusion and scoliosis correction.
Specialist Ophthalmologists evaluate, diagnose, treat, and provide consultation to, order diagnostic studies and procedures for, and perform surgical and nonsurgical procedures on patients of all ages with ocular and visual disorders, including those of the eye and its component structures, the eyelids, the orbit, and the visual pathways.
An ophthalmologist’s scope of clinical practice includes cataract surgery, clinical refraction, cornea and external eye disease, glaucoma, ocular inflammation, ocular motility, oculoplastic surgery, ophthalmic ultrasound, paediatric ophthalmology, refractive surgery e.g., corneal laser surgery and vitreoretinal disease
A gynaecologist is a medical specialist with expertise in women’s health. More specifically they manage the medical and surgical problems that affect women’s reproductive and urological systems. Urogynaecology is a sub-specialty of Gynaecology, and in some countries is also known as Female Pelvic Medicine and Reconstructive Surgery. A urogynecologist manages clinical problems associated with dysfunction of the pelvic floor affecting the bladder, reproductive organs, and bowels. Common pelvic floor disorders include urinary incontinence, pelvic organ prolapse and faecal incontinence. Increasingly, Urogynecologists are also responsible for the care of women who have experienced trauma to the perineum during childbirth.
Obstetric and gynaecological surgeons specialise in the diagnosis and management of patients in the area of reproductive health and diseases, including but not limited to women’s health issues, maternal foetal medicine, gynaecological oncology, reproductive endocrinology and infertility, and urogynaecology, male sexual disorders, post and perinatal issues.
Obstetrics and gynaecology are also involved with treatment and health provision to patients in relation to contraception, reproductive health and associated primary sexual health issues, as well as primary and secondary pathology and physiology of the reproductive system and genital tract area.
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