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A Journal on Forensic Medicine
Minerva Medicolegale 2007 June;127(2):55-62
Legal physicians fees. laws, procedures, deontology. Part one: the opinion of the physician
Massimelli M., Santovito D., Iorio M.
Dipartimento di Anatomia, Farmacologia e Medicina Legale Università di Torino, Torino
With globalisation, the “doctor in medicine” has of necessity been become part of an economic system based, exactly like any other profession or commercial activity or industry, on the relationship between costs and revenues, income and expenditure, and competition. In the last 50 years, the considerable growth in the number of court cases involving claims for damages where personal health is concerned has seen two phenomena: the unmotivated increase in the number of medical consultants in the Register available to the Judiciary Authorities, and the indiscriminate infiltration into the category of legal physicians of almost all the other specialists. The peak seen in the past 15 years is a result of the many-sidedness of biological damage and of the appearance of new types of claimable damage (direct and indirect mental, existential, loss of chances, game-playing, relational partner etc.). One of the consequences visible today is the competition between specialists in legal medicine and others, often marked by a senseless fratricidal struggle and by the tendency to cut fees in the short-sighted hope of capturing more work through lower fees. With what results? Too often the loser is the quality of professional service which fails to fully respect, when it is not completely alien to, the dictates of legal medicine criteriology, with respective debasement of specialist competence. Side effects are the discontent of the Judicial Authority already historically recalcitrant in coming to any sort of compromise with regard to the fee requests of consultants, partly because of an antediluvian system of “vacations” (so much per hour), which has seen the dilatation of trial times due to indulgently performed examinations; hence the irritation of the insurance companies, already guilty of having added to the number of their physicians many unspecialised professionals with the most nebulous of justifications (budget restrictions and shortfalls in the local area). This has led to a proliferation of court cases and the growing resentment of insured patients who have been damaged by payouts/claims considered to be captiously inadequate. From the University, once the elective site of forensic and insurance medicine, has come the idea of shedding light on and engaging with the problem. After a special issue dedicated to the culture of the free-lance legal physician (Minerva Medicolegale Suppl 1 to no. 2/2006), the journal confirms its history (it has been published without interruption for 127 years) and vitality (it publishes papers on topical themes and contemporary problems) by opening its pages to the opinions of figures such as the legal physician, lawyer, accountant, and the pertinent Union or professional association.