Commentary

In this case the judge had a number of criticisms of the expert paediatrician and as a result there was a subsequent hearing to consider whether to identify Dr G. He was invited to attend the hearing and was represented by Counsel. Dr G sought for all references to him to be anonymised in the judgment. The other parties did not support anonymisation.

Learning points

General

• Know and stay within the evidence: Distinguish established evidence from inference, hypothesis and clinical experience.

• Maintain independence: Form opinions independently rather than adopting the conclusions or terminology of other professionals.

• Read the primary evidence: Review source records, reports, investigations and images personally where they materially inform the opinion.

• Accurately characterise other evidence: Do not attribute conclusions to another expert that they did not actually make.

• Address contrary explanations: Consider plausible alternative explanations and explain why they are accepted, rejected or remain possible.

• Follow the expert-report requirements: Explicitly set out assumptions, differential diagnosis, reasoning and areas of uncertainty where required.

• Be transparent about limitations: Acknowledge limitations in the research base rather than becoming defensive about gaps in evidence.

• Separate observation from inference: Make clear what is observed, what is established, and what is inferred from those findings.

• Communicate proportionately: Avoid overstating certainty, particularly where evidence is statistical, limited or capable of alternative interpretation.

• Professional demeanour matters: A combative or defensive presentation can undermine confidence in otherwise substantive evidence.

Paediatricians

• Undertake an explicit differential diagnosis: For unexplained bruising, systematically consider relevant haematological, metabolic, infectious, dermatological and connective-tissue causes.

• Review investigations personally: Do not simply record that blood tests were "normal"; review and, where relevant, analyse the actual results.

• Obtain an adequate family history: Clarify reports of easy bruising, bleeding disorders and relevant connective-tissue features, including their severity and medical confirmation.

• Consider age and developmental stage: Interpret injury patterns against the child's mobility, activities and realistically achievable mechanisms.

• Describe injuries precisely: Record each significant bruise by location, size, appearance and other relevant characteristics rather than relying on broad descriptors such as "many" or "small".

• Correlate photographs with examination findings: Where photographs are relied upon, identify and assess the individual injuries sufficiently to demonstrate independent consideration.

• Distinguish association from diagnosis: A bruise being statistically associated with abuse does not, by itself, establish that an individual bruise was inflicted.

• Avoid inferring intention too readily: Distinguish the medical evidence about mechanism or likelihood from conclusions about a person's intention.

• Explain the evidential basis: Identify which conclusions derive from research, which from clinical experience, and the limitations of the underlying studies.

• State uncertainty and alternatives clearly: Explain where accidental injury remains possible, how plausible competing explanations have been assessed, and the degree of confidence in the final opinion.

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