why family doctors? experts in family medicine why family doctors? experts in family medicine know...
TRANSCRIPT
Why Family Doctors?
Why Family Doctors?• experts in Family Medicine
Why Family Doctors?• experts in Family Medicine• know the patient best
Why Family Doctors?• experts in Family Medicine• know the patient best• jurors have family doctors and tend
to relate to them well
Why Family Doctors?• experts in Family Medicine• know the patient best• jurors have family doctors and tend
to relate to them well• experience with chronic conditions
In What Typesof Cases?
In What Types of Cases?• “chronic pain” personal injury cases
In What Types of Cases?• “chronic pain” personal injury cases• “before and after”
In What Types of Cases?• “chronic pain” personal injury cases• “before and after”• clarify impact of pre-existing impairments
In What Types of Cases?• “chronic pain” personal injury cases• “before and after”• clarify impact of pre-existing impairments• explain clinical course
CAUSATION
CAUSATION• did the MVA cause the pt’s symptoms?
CAUSATION• did the MVA cause the pt’s symptoms?• consideration of pt’s prior hx
CAUSATION• did the MVA cause the pt’s symptoms?• consideration of pt’s prior hx• line between pre-accident and post-
accident hx is blurry
CAUSATION• did the MVA cause the pt’s symptoms?• consideration of pt’s prior hx• line between pre-accident and post-
accident hx is blurry• accident need not be the sole or direct
cause of symptoms
CAUSATION• “material contribution”
Supreme Court of Canada says: ‘Where the “but for” test is unworkable, the courts have recognized that causation is established where the defendant’s negligence “materially contributed” to the occurrence of the injury.’
CAUSATION
• positive scientific proof not required
CAUSATION
• positive scientific proof not required• recognizes multifactorial nature of
many conditions
“INJURY vs. IMPAIRMENT”
“INJURY vs. IMPAIRMENT”
• emphasis on impairment, not injury
“INJURY vs. IMPAIRMENT”
• emphasis on impairment, not injury• no functional impairment = no case
“INJURY vs. IMPAIRMENT”
• emphasis on impairment, not injury• no functional impairment = no case• injuries heal but impairments remain,
e.g. chronic pain
“INJURY vs. IMPAIRMENT”
• emphasis on impairment, not injury• no functional impairment = no case• injuries heal but impairments remain,
e.g. chronic pain• do impairments interfere with daily life
tasks?
ANATOMY OF A
MEDICAL-LEGAL
REPORT
1. Nature of document
1. Nature of document
• medical-legal report
• requested by legal representative
Mrs […] is a patient of this medical clinic under my care. I have been asked to provide some further information as to her level of functioning before and after the accident that she sustained on September 3 1998.
2. Summary of qualifications
2. Summary of qualifications
I am a qualified medical practitioner, licensed to practice in the Province of Ontario. I graduated from the University of Western Ontario Faculty of Medicine in 1993 and received my certification as a Family Practitioner from the Canadian College of Family Physicians in 1995.
3. Brief summary of pt’s hx in your care
• first contact
Mrs. […] has been a patient of mine since July 31 1996.
• pt’s past hx
When I met her she was quite a functional lady with a history of Paget's disease that was under reasonable control and a previous history of several abdominal surgeries. In general though, visits to the office were over minor concerns such as upper respiratory tract infections.
4. Details of event as related by pt
first meeting post-event
On September 4 1998 Mrs […] was seen in the office the day after an accident that happened to her in a store when a rack of picture frames fell on her injuring her right shoulder.
own examination and findings
At that time an examination was carried out and x-rays were obtained which did not show a clinical fracture.
list complaints and…
In short any activity that involves the use of her hands and arms causes pain in the shoulder girdle area. This presents a problem for simple activities of daily living […]
…functional limitations
This presents a problem for simple activities of daily living such as dressing and feeding and certainly has been a limitation with respect to her interaction with grandchildren. She has required a number of modifications to her home such as ergonomic aids in the kitchen and bathroom.
including psycho-emotional sequelae
[…] there has been a rather large psychological impact as well […]
5. Summarize history
post-event
5. Summarize history
post-event
Mrs […]'s visits to the office as of late have been for routine issues including another respiratory tract infection as well as more recently some dizziness for which a neurologist was consulted but to my knowledge no serious diagnosis was entertained and an MRI of the head was reported as normal.
6. Opinion
6. Opinion
Certainly it is clear to me that Mrs […]'s level of functioning has been quite profoundly affected by this accident and its resultant chronic pain.
7. Current status and management
7. Current status and management
dx
7. Current status and management
dx further tests & tx
7. Current status and management
dx further tests & tx anticipated benefit
of further tx
7. Current status and management
dx further tests & tx anticipated benefit
of further tx prognosis
8. Answer critical questions
8. Answer critical questions current level of function?
8. Answer critical questions current level of function? level of function pre-event?
8. Answer critical questions current level of function? level of function pre-event? cause of change in level of function?
8. Answer critical questions current level of function? level of function pre-event? cause of change in level of function? current status likely to change?
8. Answer critical questions current level of function? level of function pre-event? cause of change in level of function? current status likely to change? limitations/restrictions on daily
activities? On employability?
CONCLUSION
• Indicate that your opinions are based on:
CONCLUSION
• Indicate that your opinions are based on:–your own knowledge of pt’s hx
CONCLUSION
• Indicate that your opinions are based on:–your own knowledge of pt’s hx–pt’s chart, including consults
CONCLUSION
• Indicate that your opinions are based on:–your own knowledge of pt’s hx–pt’s chart, including consults–subjective complaints of pt
CONCLUSION
• Indicate that your opinions are based on:–your own knowledge of pt’s hx–pt’s chart, including consults–subjective complaints of pt–your own findings based on examinations
and observations
CONCLUSION• Qualify your opinion
CONCLUSION
“This is a final report based on the information currently available to me. Should more information become available later, it may substantiate or modify the opinions I have expressed. In that case, I would be pleased to provide an updated report should you so request.”
DON’Ts
• DON’T be afraid to contact the legal representative
• DON’T be afraid to contact the legal representative
• DON’T be afraid not to provide a report
• DON’T be afraid to contact the legal representative
• DON’T be afraid not to provide a report
• DON’T regurgitate your chart verbatim
• DON’T be afraid to contact the legal representative
• DON’T be afraid not to provide a report
• DON’T regurgitate your chart verbatim
• DON’T advocate unless you can substantiate
and lastly…
• DON’T overstep the bounds of your expertise
Personal Injury. Malpractice. Disability. Insurance Claims.
E X P E R I E N C E .
I N T E G R I T Y .
R E S U L T S .www.flashlaw.ca