Medico Legal

By Tonia Goman of Skin Camouflage Bristol

Skin camouflage is the application of highly pigmented creams and powders to conceal scarring, pigmentation changes, and certain skin conditions. While not a curative treatment, it provides individuals a way to reduce visibility of skin changes from trauma, surgery, or disease. Its relevance in medicolegal contexts is increasingly recognised, particularly where psychological injury forms part of a personal injury or clinical negligence claim.

The technique is non-invasive, temporary, and allows the client to manage how they present to the world. A correct product match can reduce contrast between scarred and surrounding skin. Skin camouflage products do not alter skin texture or the raised or indented appearance of a scar, their effect is visual only. Products used in traditional camouflage are specially formulated, pigmented creams and powders that are water-resistant, long-lasting, and provide sun protection.

Researchers from the Musculoskeletal Research Unit at the University of Bristol have found that eight out of 10 total knee replacements and six out of 10 total hip replacements will still be in place after 25 years. The research, funded by the National Joint Registry and the National Institute for Health Research was published in The Lancet in February.

After reviewing thousands of case studies going back 25 years across six countries, generalisable survival data is now available for the first time to estimate how long hip and knee replacements are likely to last.

In September the Ministry of Justice published the results of a consultation on medical reporting within the package of whiplash and small claims track reforms – due to be implemented in April next year for road traffic cases. The consultation ran for a month in April-May, and the resultant document sets out the government’s policy choices.

It is, however – as seems par for the course in this area – very light on detail. That is the conclusion of Alistair Kinley, director of policy and government affairs at law firm BLM.

“Given that the thrust of the proposals is much as was outlined in the consultation in the spring, it’s regrettable that the MoJ announcement of the measures has come in early September rather than in July as had been originally been expected,” he said. “That delay of a couple of months surely puts further pressure on the timetable to deliver these reforms, given that the April 2020 implementation looks to be inflexible – with 1 April 2020 mentioned in the body of the Civil Liability Act 2018.”

Doctors are increasingly expected to provide patient care in unsafe environments, where a persistent culture of blame stifles learning and discourages innovation. That is the conclusion drawn from a BMA survey: part of an ambitious project aiming to find solutions to the challenges faced by the NHS.
The project – Caring, Supportive, Collaborative – has seen almost 8,000 doctors provide accounts of their working lives across the NHS. It will go on to look at how working life can be improved.

BMA council chair Chaand Nagpaul said: “It is vital that the government and policymakers heed the views of all doctors who provide care at the coalface; they are in the best place to know the problems the NHS faces on a daily, hourly basis.

“They know the scale of impoverishment in the NHS is staggering and they are working in a culture which has improved little since the publication of the Francis and Berwick reports following the tragedies in Mid-Staffordshire five years ago.”