Post Residency, I "opted out" of mainstream hospital medicine for two years, entertaining the idea of general practice or obstetrics. After completing a Diploma of Obstetrics, working as a medical officer in the Pacific nation, the New Hebrides and for a high-altitude Himalayan Expedition, I settled down in London, obtained the first part F.R.C.S. and decided on surgery.

I commenced Urology Training at the Royal Melbourne Hospital (R.M.H.). The timing proved to be providential. The first three years were in the mould of the mythical "Sir Lancelot Spratt", massive incisions being the only option for renal stone surgery.

During my final year, simultaneous reports emerged from West Germany and the United Kingdom of "keyhole" surgery of the kidney (percutaneous renal surgery-PCNL) and extracorporeal shockwave lithotripsy (E.S.W.L.), the contact-free shattering of kidney stones by external energy sources. That year our unit performed the first P.C.N.L. in Australia.

I was fortunate to spend the next three years in London, Mainz (West Germany) and Dublin, working with the pioneers of these procedures. To put these revolutionary surgical advances in perspective, "keyhole" of the surgery predated the commonly regarded Bellwether of minimally invasive surgery, laparoscopic cholecystectomy, by at least eight years.The R.M.H. and the University of Melbourne were most supportive upon my return to Melbourne.

In collaboration with colleagues at The Royal Children's Hospital, "Keyhole" surgery was introduced to the paediatric population, and I gained the dubious honour, becoming a "Royal triplet" – one who has worked at the R.C.H., R.W.H. and R.M.H.!

I have spent the last sixteen years performing da Vinci Robotic surgery. I am currently a Consultant Urologist at Austin Health and the Olivia Newton-John Cancer Wellness and Research Centre, where I continue P.C.N.L. for the extremely complex calculi in spinal cord injury patients. I am an Associate Professor of Surgery at the University of Melbourne and have been a Urologist at the R.A.A.F. Specialist Reserve (S.Q.N.L.D.R.) for 35 years.

I began impairment assessments in 2008 after completing the A.M.A. Urological Systems Training module; however, my introduction to the medico-legal world goes back many more years following an inauspicious incident in which I was "joined" with the Head of Royal Melbourne Hospital Urology as a defendant in a surgical negligence case involving a tragic young lady with multiple psychological issues, including a Regional Pain syndrome. The litigation proceeded to the County Court by virtue of two damning "Expert Opinions". In reality, her kidney was saved by the surgery. These "Expert Opinions" were given by a Senior Vascular Surgeon and an Academic General Surgeon. Neither had any urological experience.

Within minutes of cross-examination, both had to admit that they were not familiar with ureteric reimplantation, had never performed one or indeed, even seen one!. The jury's dismissal of the allegation was a "Pyrrhic victory", given the toll of immense personal and family stress, the effect on my practice and, of course, on the patient.

In retrospect, there was a silver lining. I experienced the legal process firsthand, the profound impact of two days of cross-examination, and above all, the critical need for those providing legal evaluation and opinions to be qualified and independent.

In due course, I was invited to give opinions for negligence from Medical Defence lawyers.

I attended the Leo Cussen R.A.C.S. Workshop and joined the Medico-Legal Society in 2006.

I was invited to join Medical Panels. As a required prerequisite, I attended the AMA4 Guides Impairment Assessment Urology Module under the mentorship of Mr Gerard Joyce, St Vincent's Urologist.

Gerry established the Urology Module in 1993, and under his guidance, I became the facilitator in 2011 and remained so.

The Urology Module Representative Group consists of a doctor and two advisers representing the T.A.C. and WorkSafe Authorities.

AMA Victoria is tasked with administering Whole Person Impairment (W.P.I.) training in the method and application of "The Guides", (American Urological Association Guides for the Evaluation of Permanent Impairment, 4th Edition – "A.M.A. 4").

A doctor cannot perform W.P.I. assessments until they have completed this course.

The program is Ministerially approved by the Department of Treasury and Finance, Victoria.

Impairment is defined as "an alteration in an individual's health status resulting in the deviation of a body part or its function related to daily living".

Initially, the concept of W.P.I., a functional rather than a diagnostic assessment, can be difficult to comprehend, even though it is a medical issue assessed by medical means.

Correctly applied, W.P.I. provides a reproducible responsible fair standard assessment of the severity of an injury or medical condition.

Urologically the scope includes the Upper Urinary tract, Urinary Diversion, Bladder, Urethra and Male Reproductive Organs.

The role and responsibilities of an Assessor are multifactorial.

Firstly, to thoroughly assess and explain the physical clinical result of an injury and its effect on the client's social, employment, physical and, particularly in my field, sexual and urinary bladder functions. Secondly, to explain the clinical findings and functional results in plain non-medical language – defined as "being able to be understood by a reasonable knowledge person" so that anyone (e.g., client, family, legal team, jury, employer etc.) with interest in the assessment can easily understand the assessment, methodology, conclusions and rationale for that W.P.I. by reading your report.

As a result, W.P.I. reports represent a marked contrast to routine doctor to doctor communications.

W.P.I. assessments are intrinsic to most medico-legal work, including the Wrongs Act Certificate (an essential threshold required for litigation that regulates compensation), Independent and Joint (solicitors plus T.A.C. or Workcover Authorities) Medical Examinations and Medical Panels.

Whole Person Impairments are closely scrutinised by the legal teams and the Authorities.

If not clear, disputed or inconsistent, a Supplementary report will be requested.

This can be embarrassing, tedious, costly and time-wasting.

It is essential to provide clear, accurate and clinically supported W.P.I.'s in the first instance.

The scope of medico-legal consulting is extremely varied and includes Negligence, Panels, IME, J.M.E., Wrongs Act, opinions etc.

The majority of these require a W.P.I. Even negligence reports commonly request a Wrongs Act Certificate.

The range of assessments is stimulating, fascinating and changing – the recent Firefighters and previous Veterans Legislation recognising prostate and bladder cancer as occupational injuries are examples.

Doctors should not be reluctant to apply for training - the AMA4 Guides module is not arduous – it involves an interactive, broad, interesting and stimulating evening presentation and examination by follow up case studies at the candidate's leisure.

During the module, candidates meet the medical facilitator and the Authority Advisers from T.A.C. and WorkSafe Victoria.

The Advisors input to the module significantly complements the medical component. I find their presence very encouraging. It allows the doctors on the course to become personally familiar with the Advisors as well as their procedural input and commitment to participating in their clients' compensation.

Lastly, understanding the legal process, what Lawyers require from a W.P.I. report and comprehension of specific legal definitions such as causation, injury, impairment, performance, apportionment and stability which are germane to all medico-legal reports.

Regarding career timing, many medicos appear to be "put off" medico-legal work because it "is time-consuming and you can be called to court", therefore best to "save medico-legal work as a sinecure to provide a good income in retirement!

Solicitors are sensitive, accommodating and respectful of Experts.

I have not been called to court in the last ten years. The clinical assessment of Whole Person Impairment for a surgical patient can be comfortably completed inside an hour.

Obviously, there is pre-reading and the report post examination. However, the reports follow a formalised template and are usually straightforward.

Providing one to two-hourly slots for W.P.I.'s, IME, Workcover, T.A.C. or Wrongs Act assessments per week would be more than adequate to start.

Because W.P.I. assessments are rarely urgent and usually booked by solicitors weeks or months ahead, they do not interfere with regular consulting.

I believe the time when a practitioner becomes established and experienced, which tends to be early mid-career, presents the ideal opportunity to commence W.P.I. assessments.

The notion of funding one's dotage by medico-legal work is nearing extinction.

Many jurisdictions and solicitors already require their W.P.I. providers to be in clinical practice, at least part-time – it is critical that assessors are up to date and expert in their specialty.

W.P.I. assessments expose one to diverse and complex medical questions and involve continued learning and updating of clinical skills.

Generally, I find that most examiners find that patients are the reward – how does this apply to W.P.I.?

Injured patients are often treated by multiple specialists – in my patients mostly orthopaedic and neurosurgeons. It is often many years before a patient with urinary incontinence or erectile dysfunction is referred. Many have been "too embarrassed to complain" or have required major surgery as a priority.

As a result, the Urological assessment is often the first time a patient discovers or understands the cause of their symptoms and that there are options for testing and treatment.

Although a W.P.I. assessor cannot advise, treat or advocate, their W.P.I. reports are scrutinised by their client's solicitors, T.A.C. and WorkSafe facilitators.

Should a W.P.I. suggest a patient needs investigation, rehabilitation or other specialist referral, they will facilitate these, so indirectly, W.P.I. reports can make a considerable contribution to a client's medical management.

Patients regularly express gratitude that someone has listened to their concerns in such detail.

By far the most challenging aspect of W.P.I. for me is the exposure to the tragedy resulting from severe trauma, in particular, that involving young males, who, in a "split second", have become paraplegic, incontinent, impotent, alone, overweight and depressed – always tragic, distressing and heartbreaking.

One can only hope that their W.P.I. reports offer at least some hope, palliation, ongoing support and recompense.

Medical practitioners are extremely fortunate. Our training and experience enable us to modify and change direction.

The process of W.P.I. is integral to Medico-legal consulting.

W.P.I. discipline provides an excellent template for a thorough evaluation of a wide range of injuries.

My experience with W.P.I. has developed a profile with Solicitors and Medical Defence organisations throughout Australia.

On a personal level, many colleagues are aware of my experience and seek counsel regarding their personal cases or when writing reports, which is very gratifying.

W.P.I. opens a myriad of opportunities to apply one's years of clinical experience, an ongoing, fascinating, challenging and rewarding experience.