Lawyer Monthly Magazine - July 2019 Edition

Rheumatology and Spinal Pain Management GENERAL MEDICINE JUL 2019 54 Expert Witness www. lawyer-monthly .com What are your main areas of expertise as a Consultant Physician? Can you give some insight into them? My specific subspecialty training is in Rheumatology, the branch of medicine which deals with inflammatory, immune, mechanical and other diseases of the musculoskeletal system. These are often multi-system immune diseases and may be diagnostically complex. There are around 200 rheumatic conditions with extensive overlap with internal medical problems, therefore traditionally, Rheumatologists are considered widely based clinicians which I believe helps in assessing complex medico-legal cases. What brought you to your special interest in the interventional management of spinal pain? Unmet patient need. Patients with back pain are frequently sent to Rheumatologists who will often reassure them they don’t have a disease they have never heard of (Ankylosing Spondylitis) or manage the problem as “pain”. It was the question “well what do I have?” that set me on the way to find the Spinal Intervention Society in 2000. This group is dedicated to the best scientific and technical standards in interventional pain management and to espouse the concept of precision diagnosis before treatment. Based on this firm foundation, I have built an additional, almost unique skill in the diagnosis and treatment of spinal pain of all types and particularly of intervertebral disc pain, a common but neglected area of spinal pain medicine. Patients with this problem have a high probability of leaving my hands “I did a fair amount of medico-legal work earlier inmy career then stopped as things became hectic”, Anthony Hammond tells us. “Returning to the modern medicolegal environment has been greatly aided by the excellent courses and certification supplied by Bond Solon. My experience, sense of clinical balance and forensic reading of the records for the clinical context are all highly suited to current medicolegal practice and I believe assist in allowing me to offer high-quality advice, particularly in complex cases.” He speaks more here about his expertise as an Expert and Rheumatologist. with an effective resolution of the problem, but if seen by others, they will often be mislabeled with chronic pain or ‘fibromyalgia”. What kinds of cases might require your expertise as an expert witness? I have been instructed in complexmedical andpain cases and in clinical negligence in the treatment of rheumatic diseases such as RA, Spondyloarthropathy and SLE. Experience and a deep understanding of the UK medical system are helpful in assessing these issues. I deal with chronic pain on a daily basis and can be instructed here as well. A particular area of expertise is based on my experience of diagnosis and treatment of damaged intervertebral discs and the potential exacerbation in accident and road traffic accident and in cases of whiplash. Concepts of disc pain and mechanisms of whiplash injury and treatment are not commonly advanced in UK practice, including established orthopaedic opinion. Have there been any recent advancements in the detection and treatment of rheumatoid diseases? Diagnosis in rheumatic diseases still relies on measuring the balance of history, signs and complex immunological testing. Rheumatic diagnoses are often fluid and may turn on small details, though applying investigations comprehensively helps. Experience remains essential. In spinal cases, formal identification or exclusion of pain generating spinal structures usually requires a step beyond imaging with the kind of interventional diagnostic blocks and provocation championed by the Spinal Intervention Society for whom I now teach and lecture. This concept may not be adequately widely recognised. LM I am Dr Anthony Ham- mond. I graduated from Edinburgh Medi- cal school in 1980 and trained in General Medi- cine (GIM) and Rheu- matology in Edinburgh, Bristol, Bath and London. Interest in Rheumatol- ogy commenced with experience in the Royal National Hospital in Bath and continued with writ- ing a doctoral thesis in Lupus in the laboratory of Professor Sir Mark Walport in the Royal Postgradu- ate Medical School, London. I was appointed General Physician and Rheumatologist at Maid- stone, Tunbridge Wells NHS Trust (MTW) in 1992 and ran a busy medical and Rheumatology unit there for 20 years, build- ing from single-handed to three colleagues, two Nurse specialists and 2 research nurses. I took part in research and de- signed investigator led trials in novel therapeu- tics n RA. At all times I was pro-active in seek- ing new treatments for unmet need and was amongst the first in the country to be able to de- ploy biologic therapies in RA establishing a com- bined countywide com- mittee to ensure open access to these impor- tant new therapies. Dr Anthony Hammond MD FRCP Consultant Physician and Rheumatologist Haywood House, Hydra Business Park, Nether Lane, Sheffield, S35 9ZX E: enquiries@mlas.co.uk T: 0114 245 5423 DR ANTHONY HAMMOND CONTACT