“Clinical Correlation of Patient Findings”
WARNING: If you have not read all previous consultations, then you stand the chance of being a “one-and-done” with the lawyers. You have to learn to speak their language of admissibility.
This consultation is about the ass and the elbow. You know the old story, if the ass doesn’t match the elbow, then it doesn’t make sense.
When you have a patient that has cervical problems, many doctors list lumbar findings without any lumbar symptomatology. This is very confusing to all parties. It is possible to have problems in areas that the patient doesn’t complain about due to the gating mechanism, but again, this is very confusing to all in the medical-legal field and usually will not be admissible unless clinically correlated.
One of my mentors, an attorney that I worked with for over a decade, would take my narrative and mark it with a red pen and then grade it. In the beginning he would return my narrative with an “F” and I wasn’t very happy with him. After my large ego got out of the way, I realized that I wasn’t very happy with me. His message was that I didn’t clinically correlate the accident with the history and functional and structural findings and then correlate them with functional loss. If you understand the preceding sentence and can put on paper that fact pattern, then you understand the most important part of a narrative. Let’s say that again; if you get it, then you win!!!!
When attorneys, adjustors, opposing counsels and judges read a medical report, they usually start at the end and read the conclusion first, as most don’t understand the medical jargon written before the conclusion. Therefore, your conclusion becomes the most important component of your report. After speaking to 1000’s of lawyers, this fact has been confirmed. The conclusion needs to “causally relate the accident to the patient's problem.” It must be within a “reasonable degree of medical certainty.” It must certify any permanencies and synopsize the entire report in 1-2 short paragraphs.
The next two statements should be part of the conclusion that resolve all but one of the issues in the above statement, if clinically accurate:
“This accident caused damage that has been evidenced, as noted above, which has caused the ensuing functional problems that are permanent.”
“It is my opinion, within a reasonable degree of medical certainty, that the above objective and quantitative findings as described above have caused permanent and consequential limitations, which are a direct result of the injury caused on X/XX/XXXX.”
Whether you are a chiropractor, medical doctor, osteopath or podiatrist, it is usual and customary to say “medical certainty” for the courts. Regarding the clinical correlation, this is where your report starts to become unique and separates you from the rest of the treating community. You need to state how the accident happened, state the symptoms of the patient and then list the objective findings specific to that region.
“Mrs. Jones was in a rear end collision while stopped. She is experiencing neck pain that radiates from her left shoulder down into her left arm. Her MRI revealed a herniation on the left at C5 compressing the left C5 nerve root. Her EMG was positive for radiculopathy at C5 on the left. She is unable to lift her left arm up as a normally functioning person does as a result of the bodily damage as evidenced by the positive test findings reported above.”
You must, in the body of the report, discuss how you came to the findings in your conclusion. Afterwards, you need to list the functional loss of the patient that was previously discussed and clinically correlates to the bodily damage.
Once you complete this process, you have successfully clinically correlated the patient’s symptoms, structural, functional findings and functional loss to the accident. This is what you want to focus on when communicating with a patient’s lawyer, as this is what they have been seeking and few understand the process. Even among those that do understand the process, most cannot put it on paper.
You now have all of the tools to create an excellent framework for a narrative. You always have the option of purchasing a template in “Forms and Templates” on the Web site should you need more help. I am also available to help you in a specific case; just drop me a note or call.