Why Family Doctors Why Family Doctors experts in

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 Types of 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 postaccident hx is blurry

CAUSATION • • did the MVA cause the pt’s symptoms? consideration of pt’s prior hx line between pre-accident and postaccident 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. chronic pain

“INJURY vs. IMPAIRMENT” • • emphasis on impairment, not injury no functional impairment = no case injuries heal but impairments remain, e. chronic pain do impairments interfere with daily life tasks?

ANATOMY OF A MEDICALLEGAL REPORT

1. Nature of document

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. 1. Nature of document • medical-legal report • requested by legal representative

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. 2. Summary of qualifications

3. Brief summary of pt’s hx in your care

Mrs. […] has been a patient of mine since July 31 1996. • first contact

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. • pt’s past hx

4. Details of event as related by pt

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. l first meeting post -event

l own examination and findings At that time an examination was carried out and x-rays were obtained which did not show a clinical fracture.

l 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 […]

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. l …functional limitations

[…] there has been a rather large psychological impact as well […] l including psychoemotional sequelae

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 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 l dx

7. Current status and management l dx l further tests & tx

7. Current status and management l dx l further tests & tx l anticipated benefit of further tx

7. Current status and management l dx l further tests & tx l anticipated benefit of further tx l prognosis

8. Answer critical questions

8. Answer critical questions l current level of function?

8. Answer critical questions l l current level of function? level of function pre-event?

8. Answer critical questions l l l current level of function? level of function pre-event? cause of change in level of function?

8. Answer critical questions l l 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 l l l 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. EXPERIENCE. INTEGRITY. RESULTS.