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A Day in the Life of an Expert Witness

Medico Legal

Hugh Koch, Clinical Psychologist and Visiting Professor in Law & Psychology to Birmingham City University

Try asking yourself or a colleague what interesting things happened to them in the past five working days. It is surprising how fascinating people’s lives are both at work and at home. Any one of those five days will have some intriguing moments interspersed with necessary and mundane ‘filler’ moments. The ‘day’ described below is an amalgam of some of my recent work experiences which both, at the time, and on reflection at a later date, make me remember how much I enjoy my work.

Any time after 5:30am, I start to awake from my slumber. A small headache is replaced by anticipation for the day ahead. Depending on the degree of closure, the night before, about uncompleted or difficult tasks, I try to focus on a positive thought or expectation.

Today, I’m travelling to middle England for a 7 hour clinic – the taxi and train on time are a good start. The new trains travelling east to London, south to Exeter and north (with me) to Manchester fascinate me, reminding me of a human-size Hornby Train Set. A relaxed walk along the platform reminds me of Dad’s similar early morning promenade on Rickmansworth Station back in the day.

Arriving at my destination station, I have already had one coffee (an early morning ‘must’) and conversations with taxi driver, ticket provider and ‘on train’ host – about non-consequential but ‘warmup’ topics. When I arrive at my destination, my taxi driver at the front of the station rank is engrossed reading a book which given his and the book’s appearance make me think his book is the Koran – I interrupt his train of thoughts as we move off asking if his book is interesting. He tells me that ‘all things around us are found in this book’, I’m not usually lost for words but the guy’s fundamental or black and white belief stops me in my track and we sit in agreeable silence for 10 minutes to my destination.

I arrive at my clinic, based today in a well-known private hospital for a six hour medico-legal clinic. The environment is great: clean, tidy, not crowded and run by happy administrative and nursing staff who welcome me with a smile and my name. I have a potential new colleague sitting in with me today to watch how the medico-legal interview takes place and see if she wants to join my team. She arrives at 08:45am so I can brief her on what to expect.

The first half of my day consists of meeting five people coming to see me for a variety of reasons.

They include:

• Someone adjusting to adverse life events including work stress and a close family member diagnosed with terminal cancer

• A driver dissociating due to by a recent motorway rear shunt who has flashbacks to the noise and the scene of the crash

• A 40 year old woman who had a shoulder injury and now has what’s called ‘functional overlay’ due to her depression and pain becoming, in her view, inextricably linked

• A man from a poor African country who, following a work injury developed ‘catastrophic’ negative thinking and low mood

• Someone who having just overcome travel fear following a nasty road accident had a further even more frightening road accident a week before seeing me.

A walk to get a quick sandwich and fresh air rejuvenates me for the next session.

In the afternoon, my clinic consists of three claimants, all of whom are bringing a personal injury claim following a road accident (2) and a work accident (1). The first is an Afghanistan taxi driver who has been in the UK for ten years and recently had a road accident in which an oncoming bus driver misjudged space and collided with his cab. He was very depressed about the adverse effect this episode had had on his confidence and financial livelihood. Having completed the interview and obtained the necessary information for me to complete a report, I asked him what work he had done in Afghanistan before coming to the UK, and his face which had been very sombre for the past 45 minutes, lit up and he became much more animated. “Oh”, he said, “I was an Afghani Air Force Pilot”. The next 10-15 minutes were spent with him recounting his fascinating and eventful life back home.

A quick coffee, a phone call to my office to clarify an administrative matter, and I was reading my notes for my second client. He was a factory worker who was responsible for the process of producing metal plating for beer cans (famous ‘yellow/orange’ brand) – he had been involved in a machine malfunction whereby his right hand had been trapped for 30 seconds. He had suffered a significant injury to his hand with referred pain up his arm to his shoulder. Being right handed, this injury had a significantly adverse affect on working and also his leisure life as a guitar player and his domestic activities. Despite these adverse effects, he had maintained a resilient and emotionally robust attitude and despite minor mood and sleep disturbance had tried very hard (and succeeded) to continue working and keeping positive.

The third claimant was a man who had been riding a motorbike when a lorry emerged suddenly from a right hand turning and collided with him and his bike. He had suffered significant and extensive right leg and arm injuries, losing his right leg and was now dependant on a wheelchair for mobility. He was agitated, angry and depressed with what had happened, which was very understandable. Following my assessment, I recommended cognitive-behavioural therapy sessions to help him adjust emotionally to such extensive and life-changing injuries. Although this wouldn’t alter the physical disabilities he had, I hoped therapy would help him adjust and cope even better emotionally.

Seeing and talking to people who have had moderate or, at times, severe injuries and trauma not only makes one feel very sympathetic to others but also, inevitably, makes one grateful for one’s own good fortune and lack of disability. It also shows how resilient people are in adversity. You hope that your own response to them has, in some small way, helped them or given them an empathic and genuinely caring response.

What a cosmopolitan and fascinating group of very different individuals. Irrespective of why they came to my clinic and whether or not I was able to help them, they offered me a valuable insight into different nationalities, different stresses and strains, as well as the main presenting problems they came with.

My taxi arrived at 5pm to start me on my one and a half hour journey back home – the driver invited me, on questioning, to guess his country of origin – overcoming my fear of offending him by getting it wrong, I guessed Iranian (he was Iranian Kurd). He then disclosed during the ten minute journey to the station plus a further ten minutes parked, that his Polish wife of 8 years (and 3 children) wanted to leave him and what could he do – a genuinely distressed guy. We discussed some of the life factors that may have contributed to this unhappy situation. I felt I had been sympathetic but had a dilemma that I wanted to help more but, 100 miles from home, did not think this practicable – I felt I had listened and ‘witnessed his distress’.

A ten minute drive back to my office and an hour’s paperwork to draft my three reports from the clinic. Then a 15 minute catch up with the office staff before phone calls. With over 50 colleagues around the UK carrying out similar clinics, I often get phone calls from them wanting to share a particular interview- related issue. These never take long, are interesting and a valuable way of keeping in touch with colleagues. Typically, some helpful clarifications and suggestions from me resolve some ambiguity in any one particular case and give them support and confidence.

As well as my medico-legal and clinical/treatment work, I also enjoy writing, professionally and usually have one or two articles or a book/book chapter ‘on the go’ at any one time. The next hour is spent reviewing a draft of a paper describing a case report on specific travel phobia to be submitted by the end of the week.

Looking at my iPad diary, I review and take stock of my commitments for next week – a clinic in London, a case conference in Bristol, some telephone discussions on problematic cases and ongoing working commitments in the office. Not all my time is diarised as unforeseen requests or demands on my time will happen plus time for essential and very welcome coffee breaks.

Returning to my comments at the start of this article, it is usually not difficult for me to find my “five intriguing moments” – sometimes I share them with someone who is interested to listen and sometimes I just log them in my own memory bank to reinforce how much I enjoy my job!

This paper is an amalgamation of two chapters in books published by Hugh (Koch, 2016; 2018).

Koch HCH (2016) Legal Mind: Contemporary Issues in Psychological Injury and Law. Expert Witness Publications. Manchester.

Koch HCH (2018) From Therapist’s Chair to Courtroom: Understanding Tort Law Psychology. LCB Publications. Manchester.

Hugh Koch is a clinical psychologist and visiting professor in Law and Psychology at Birmingham City University.

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