Uneasy Bedfellows in Court?: a Psychiatrist on Orthopaedic

Even before working as a medical expert I could personally attest that Orthopaedic surgeons would always beat you at squash, out-ski you and drink you under the table. One common factor shared by these two professions is that they are probably the most frequently instructed medical experts in personal injury litigation and by virtue of this invariably cross-paths in barrister's conferences and the courts. It is therefore tempting to rely on personal observation or well-worn stereotypes when characterising orthopaedic experts but I have looked at the medical literature, for a more authoritative and less biased view, which is revelatory in its rather bizarre detail.

It is probably no surprise that Orthopaedic surgeons are more inherently verbally aggressive and hostile than psychiatrists (Wright et al, 2012) or that psychiatrists have more open personalities and are more agreeable than Orthopaedic surgeons (Deary et al, 2007), which of course, also means that psychiatrists are more open to exploitation. Psychiatrists, who do not have to get up in the middle of the night to operate and rarely work at weekends, have less work-related stress and they report fewer clinical work demands than Orthopaedic surgeons (Deary et al, 2007).

However, this is where the questionably good news for psychiatrists comes to an abrupt end. Orthopaedic surgeons park their cars more quickly and are more attractive and taller than psychiatrists (Antoni et al, 2006; McCail et al, 2010). I also know that they have more expensive and flashier cars than psychiatrists. Admittedly, I do park my car quite slowly, but exceptions  always prove the rule and I know a very tall psychiatrist and a short (though unquestionably good looking) Orthopaedic surgeon. Orthopaedic surgeons are stronger and have larger hands than psychiatrists (Barrett, 1988; Fox et al, 1990), which does not  particularly concern me - inferences aside.

Orthopaedic surgeons are more extroverted and are more emotionally stable and less neurotic than psychiatrists (McGeevey et al, Deary et al, 2007). How many psychiatrists do you know that are planning their holiday steel-head fishing in Columbia?!

Slightly more worrying is that psychiatrists are less conscientiousness about their work than their Orthopaedic colleagues (Deary et al, 2007). They suffer from lower levels of job satisfaction (Baldwin et al, 1997; Firth-Cozens, 2000) and who honestly would not prefer to be praised for replacing a  worn out hip than be beaten up by a cocaine dealer? Psychiatrists have more disciplinary actions against them at work than Orthopaedic surgeons (Dehlendorf & Wolfe, 1998) and in particular, psychiatrists have a higher proportion of disciplinary actions for substance misuse than Orthopaedic surgeons (Shore, 1982). Male psychiatrists are more often disciplined than Orthopaedic surgeons for having sexual relationships with patients (Morrison & Morrison, 2001).

Psychiatrists (who clearly should know better) are more likely to be depressed and have more burnout than Orthopaedic surgeons (Deary et al, 1996 ; Kumar et al, 2005). It seems the GMC is impotent to stop psychiatrists in training using more cocaine, LSD, and cannabis than Orthopaedic surgeons (Myers & Weiss, 1987). You may be interested to know that trained psychiatrists tend to favour benzodiazepines, amphetamines and cannabis (Hughes et  al, 1992). I find it hard to believe, that psychiatrists are over-represented at Alcoholics Anonymous compared to Orthopaedic surgeons (Bissell & Skorina, 1987) but perhaps they are more "open" to admitting they are alcoholics. Psychiatrists are more like to commit suicide than Orthopaedic surgeons (Hawton et al, 2001), probably because they know the tricks of the trade.

The final coup de grace is that psychiatrists show significantly raised mortality compared with Orthopaedic surgeons and are particularly more likely to contract ischaemic heart disease, injury, poisoning , and colon cancer (Carpenter et al, 2003). I am fairly sure than even Orthopaedic surgeons eventually die of something.

However, much it pains me to admit it, there is no getting away from the fact that Orthopaedic surgeons are the top-guns of medicine; the Maverick's to the Mr Bean's and while I am sure this article has not revealed anything to you that you did not know already, the very least you can now do is to recommend me to your instructing solicitors.

Dr Leigh Neal is a Consultant Psychiatrist who has been providing personal injury reports to the legal profession for 20 years. He has prepared 100 to 150 personal injury reports a year for defendants and claimants involved in personal injury actions since 1994 He has attended training courses in the responsibilities of an expert witness and report writing. He has considerable experience as an expert witness in the High Court and County Court, giving evidence on average 5 times a year since 1994.

Author: Leigh Neal, Cobsultant Psychiatrist

This article was first published in the January 2014 edition of the JTO.