In this episode of The Consult by Australian Specialist Hub, Hanna sits down with neurologist and clinical neurophysiologist Dr Janaka Seneviratne to talk about the work behind the diagnosis, and why medico-legal neurology is rarely as straightforward as it looks on paper.
Dr Seneviratne shares what first drew him to medicine, a hospital stay in his early teens and the team who looked after him, and how mentors later led him into neurology and neurophysiology. He breaks down the differences that confuse most people: what separates a neurologist from a neurophysiologist, and where neuropsychology fits in, particularly when assessing head injuries and cognitive impairment.
He also explains how much neurology has changed over the past 10 to 15 years. The field has grown so much that most neurologists now subspecialise, with separate experts in multiple sclerosis, epilepsy, headache and neuromuscular disease. As a neurophysiologist, Dr Seneviratne makes and confirms the initial diagnosis, then refers patients on to the right colleague or specialist clinic when ongoing, multidisciplinary care is needed, such as the neuromuscular clinic at Bethlehem Hospital for motor neurone disease.
Much of the conversation sits in the medico-legal space, where Dr Seneviratne has worked for more than a decade alongside his private practice. He explains how he uses both clinical skill and EMG and nerve conduction studies to diagnose nerve and muscle disorders, and shares two cases that stayed with him: a woman in her 30s referred for a concussion injury who turned out to have multiple sclerosis, and a manual worker referred for a fitness for duty assessment whose symptoms pointed to motor neurone disease. In both, an independent assessment fast tracked the right diagnosis and treatment, a reminder that early intervention can be life changing.
We also get into the duty of care that independent medical examiners carry, including the spots and red flags that surface during an assessment for something else entirely, from an advanced melanoma noticed on the skin to an orthopaedic problem picked up in a psychiatric review. Dr Seneviratne puts it, if something does not sit right with the presentation, you have to do the right thing by the patient.
For referrers, Dr Seneviratne offers practical advice on writing a clear letter of instruction: send all the supporting documents ahead of time, and be specific about what you want assessed and commented on. He also unpacks one of the trickiest diagnoses in his field, thoracic outlet syndrome, the difference between the neurogenic and vascular components, why nerve conduction studies alone are not always conclusive, and what makes impairment assessment so difficult under the AMA guides.
For any neurologist sitting on the fence about medico-legal work, Dr Seneviratne makes the case for giving it a go. The conditions may be familiar, but the work is different, the cases are varied, and you never quite know what is coming through the door.
Whether you are a referrer, a fellow specialist weighing up the medico-legal scope, or simply curious about how we listen to nerves and muscles, there is plenty here.
About Australian Specialist Hub
Australian Specialist Hub connects referrers with leading independent medical experts across a wide range of specialties, including neurology and neurophysiology. If you have a medico-legal matter that needs the right specialist, we make the referral process clear and straightforward.
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To make a referral or learn more, visit https://aushub.com.au/ or get in touch with our team at 1800 287 482 or [email protected]. Subscribe and follow The Consult for more conversations with the specialists behind the assessments.
