Neurology can be a complex area of medicine, particularly when symptoms, investigations and clinical findings do not always provide a straightforward answer.

We speak to Dr Christopher Kwan, Neurologist, in our episode of The Consult about his journey into neurology, his experience in medico-legal work and the challenges involved in assessing neurological conditions in legal matters.

From workplace and motor vehicle accidents to post-head injury symptoms, chronic pain and questions of causation, Dr Kwan shares his approach to assessing complex neurological matters and communicating medical evidence clearly.

From Medicine to Neurology

Dr Kwan explored a range of medical specialties before choosing neurology. He was drawn to the specialty because of its combination of practical problem-solving, abstract thinking and the diversity of conditions encountered in clinical practice.

This approach has also informed his work in medico-legal assessments, where neurological symptoms and their causes may not always be straightforward.

The Complexity of Neurological Assessment

Neurological assessment often involves a combination of clinical history, examination findings and investigations.

While MRI, CT and other neurological tests can provide valuable information, they do not always give a complete answer. Some symptoms may not be visible on imaging, while other conditions can present in ways that overlap with different neurological disorders.

Dr Kwan highlights the importance of considering the whole clinical picture rather than relying on an individual test or finding.

Neurology or Neurosurgery?

Understanding the distinction between neurology and neurosurgery can be important when referring a medico-legal matter.

Neurosurgery generally focuses on structural conditions that may require surgical treatment, while neurology covers conditions such as multiple sclerosis, epilepsy, stroke, movement disorders and dementia.

With some matters involving areas of overlap, selecting the appropriate specialist can help ensure the relevant clinical questions are properly addressed.

Clear Reports and Clear Questions

For Dr Kwan, a good medico-legal report should be concise, clear and accessible to a non-medical reader.

The same applies to the Letter of Instruction. Clear questions help the specialist understand what needs to be addressed and provide an opinion that directly responds to the issues in dispute.

Rather than simply presenting test results, the report should explain the reasoning behind the conclusions and place the medical evidence in context.