The UK medicolegal climate has changed dramatically over the past 120 years. Ophthalmologists now are subject to far greater scrutiny than ever before. We call it multiple jeopardy. From just one single incident ophthalmologists can be held accountable and have their professional conduct scrutinised in numerous ways: by the civil and criminal courts and coroners, by their employers, the National Clinical Assessment Service, and the regulatory body, the General Medical Council (GMC); through the NHS or independent sector complaints procedures and the healthcare regulator, the Healthcare Commission. The editor of the BJO suggested a title of “insuring ophthalmologists” for this article and, in that context, since 2000, the Medical Defence Union (MDU) has provided MDU members with an indemnity insurance policy for clinical negligence claims. However, as well as claims, hundreds of ophthalmologists every year turn to us for advice and assistance with many other equally important medicolegal matters, which I will touch on too.

INSURANCE—THE CURRENT POSITION

Many doctors do not realise that just under half of the United Kingdom’s practising doctors do not have professional indemnity insurance. MDU members have been provided with individual insurance contracts since 2000, a move not yet taken by the other UK defence organisations, whose members are indemnified on a purely discretionary basis.

This may seem strange, given the global medicolegal climate and the dramatic increase in negligence claims worldwide over the past 20 years. Many readers may not even know what discretionary indemnity is. Historically it was widely used as a means of indemnifying doctors, but has caused problems in many countries. Insurance is now mandatory in many EU states, most of the United States, and Australia. Unlike insurance, discretion …