The vascular patient as a litigant.

First medico-legal reports were written on 97 consecutive vascular patients (M-74; F-23). There was a four-fold increase in requests, from 17 reports in 1985-90 to 80 reports in 1990-95. There were 48 reports in connection with medical negligence claims with equal numbers instructed for the plaintiff patient and the defendant doctor; 32 industrial injury reports for vibration white finger; and 17 reports after work and road accidents. For medical negligence cases, the mean patient age was 47 years and 40 per cent of litigants were women. Twenty-one of 27 reports in arterial cases supported the defence, compared with seven of 16 venous cases and four of five others. Claims arose when advice or a procedure was followed by an unexpectedly bad outcome, such as amputation, paralysis or death, and following lesser damage when pre-operative expectations were high. Independent sympathetic explanations were helpful when patients and relatives experienced difficulties in coming to terms with seriously adverse events. Factors associated with successful defence included senior clinical involvement, clear and complete medical and nursing records, and the seeking of a colleague's opinion when a complication occurred. These findings show an increase in medico-legal activity which shows no sign of abating. It is likely that many more reports will be required in the future, to respond to overtures from vascular patients and their advisers.