Disagreement does not necessarily mean that one expert is wrong or that the evidence is unreliable. Medicine often involves judgement, particularly where symptoms are subjective, records are incomplete or more than one explanation is medically possible.
The important question is not simply whether experts agree. It is whether each expert can explain how the opinion was reached, what evidence supports it and why a different interpretation has been rejected.
Agreement should not be forced.
Experts should approach disagreement with an open mind. They should be willing to reconsider their reasoning, correct mistakes and change an opinion where further information justifies doing so.
That does not mean they should compromise merely to produce a single conclusion.
An expert who has reached a properly reasoned opinion should not abandon it because agreement would be more convenient for the instructing parties. Equally, an expert should not defend an earlier conclusion simply because changing it may cause difficulty for the party who requested the report.
The purpose of a discussion between experts is to identify areas of agreement, clarify the remaining differences and determine whether those differences can be narrowed through further information or explanation.
It is not a negotiation. Medical opinions should not be exchanged like competing offers.
Finding the real cause of the disagreement.
Experts sometimes appear to disagree about diagnosis when the real difference lies elsewhere.
They may have been given different records. One may have reviewed occupational-health documents, previous imaging or earlier general-practice notes that were not available to the other. They may also have been asked different questions or provided with different accounts of the incident.
The disagreement may arise because the experts have made different factual assumptions. One may accept that symptoms began immediately, while the other relies on records suggesting a delay. One may understand that the claimant had no relevant previous symptoms, while the other has identified a history of similar complaints.
Before debating the medical conclusion, the experts should establish whether they are working from the same information.
Terminology can also create unnecessary disagreement. Words such as “recovered”, “resolved”, “chronic pain” and “functional restriction” may be used differently. One expert may mean that the original tissue injury has healed, while another interprets recovery as the complete absence of symptoms.
A useful discussion identifies whether the disagreement is genuine or whether the experts are describing the same position in different language.
How expert discussions should be approached.
A productive discussion should be structured around the issues rather than around the personalities involved.
Each expert should explain the factual basis of the opinion, the clinical reasoning used and the significance given to records or findings. The discussion should concentrate on diagnosis, causation, prognosis, treatment and functional effect where these matters remain disputed.
Experts should listen carefully to each other’s reasoning. It is easy to prepare a response while the other person is speaking rather than considering what is being said. That approach turns the discussion into a debate and makes meaningful agreement less likely. A neutral list of questions may help keep the discussion focused. Questions should be clear and should not be written in a way that assumes one expert’s opinion is correct.
For example, asking why an expert “ignored” an accident and emergency note is unnecessarily hostile. It is more useful to ask what significance the expert attached to that note and how it affected the opinion.
The tone should remain professional. Disagreement does not justify personal criticism.
Changing an opinion is not a failure.
An expert may change an opinion after reviewing additional records, hearing another explanation or recognising that an earlier assumption was incorrect.
That is not necessarily a sign of weakness. A willingness to revise an opinion in response to better evidence is part of responsible expert practice.
The reason for the change should be made clear. It is not enough to state that the expert now agrees with the alternative view. The expert should identify the information or reasoning that caused the change and explain how it affects the original conclusion.
A significant change may require a revised report or an addendum. The instructing party should be informed promptly, particularly where the new opinion affects diagnosis, causation, prognosis or recommended treatment.
Experts should not wait until the final stages of a claim before revealing that their view has altered. Delayed disclosure may create confusion and raise questions about how carefully the evidence was reviewed.
When disagreement remains.
Some differences cannot responsibly be removed.
This is particularly common in cases involving chronic pain, psychological symptoms, uncertain prognosis, multiple accidents or limited contemporaneous records. The available evidence may support more than one reasonable medical interpretation. Where disagreement remains, it should be described accurately and briefly. The experts should identify what is agreed before setting out the remaining differences.
A clear summary might state that both experts accept the claimant sustained a soft tissue injury but disagree about whether the ongoing symptoms remain attributable to that injury. Each expert can then provide the main reason for the opinion. This is more useful than repeating two full reports or producing lengthy criticism of each other’s methodology.
Experts should also identify whether further evidence might assist. This could include missing medical records, updated imaging, employment information or an assessment from another clinical discipline.
Further evidence should not be requested merely because the experts disagree. It should have a realistic prospect of helping to resolve a particular issue.
Avoid artificial compromise.
There can be pressure to find a middle position. Sometimes that is appropriate. An expert may accept, for example, that an incident temporarily aggravated a pre-existing condition even though it did not cause the underlying problem.
However, a compromise should only be adopted where it represents the expert’s genuine medical opinion.
If one expert believes the current symptoms were caused by the incident and the other believes they were not, it may be tempting to agree that the incident made some contribution. That wording should not be used unless both experts consider it medically supportable.
Artificial agreement creates uncertainty rather than resolving it. It may conceal the real issue and make the final evidence harder to understand.
Independence matters most during disagreement.
An expert’s independence is tested most clearly when another expert presents a persuasive challenge or when the instructing party prefers a different conclusion. The expert should remain open to correction but should not be pressured into agreement. The opinion must continue to reflect the evidence and the expert’s professional judgement.
Experts should also remain within their area of expertise. A disagreement should not encourage them to offer opinions on matters better addressed by another specialist.
For example, an orthopaedic expert may comment on physical findings but should be cautious about making a firm psychiatric diagnosis. A psychologist should not present an opinion on structural injury without appropriate expertise.
What happens when experts cannot agree is therefore less dramatic than it may first appear. They identify the points they share, explain the issues that remain disputed and record the reasons for their different conclusions. The proper outcome is not agreement at any cost. It is disciplined disagreement: clearly expressed, supported by evidence and free from personal or commercial pressure.
A well-reasoned difference of opinion is more useful than a false consensus. The expert’s responsibility is not to make the evidence appear tidy. It is to make the reasoning transparent.
