“Narratives and Added Value Services to the Lawyer”
When writing narratives, the number one mistake that is made in the profession is that doctors write reports as if they are letters of necessity to insurance companies. It is not important to note that as a result of the examination, the patient will need a course of therapy for 3 weeks, including heat, e-stim, adjustments, etc. It is not important to note that care was recommended to eliminate vertebral subluxation in order to remove distortions in the human body. It is not important to note that care was recommended for the purpose of future degeneration that will occur if there is ligament laxity. None of this is important and in fact, much of it is inadmissible.
Most doctors write a history of the problem and explain what happened in the accident and leave out the symptoms of the patient. Symptoms are very important in the history. They set the foundation of what and where you are going to examine and help to determine persistent functional loss. Other doctors write the symptoms of the patient and then leave out the causal relationship. There must be both.
You start a narrative with the accident history. Be general, as you are not an accident reconstructionist. “Mrs. Jones was hit from the rear while stopped and was wearing a seatbelt.” Do not get into the fact that the car hitting her was going approximately 40 mph. You don’t know for certain that the car was going 40 mph and if challenged, you will not be able to defend those words.
After the accident history, you need the current history; what the patient is feeling now. This is critically important as it builds the foundation for persistent functional loss. Be specific, but do not add persistent functional loss as explained in previous consultations. You are going to save that for the conclusion.
Prior history must be in the report. Did the patient have any pre-existing issues? Are they related to the injury or do they have any relationship to the injury? You must state that. For example, “Mr. Jones broke his right wrist 15 years ago in a sporting injury. It has healed and he has had no treatment since. This injury has no bearing on his current injuries.”
When writing up the examination, the courts are used to seeing a complete physical examination, including height, weight, blood pressure, family and social history. This all lends itself to credibility as a valued part of the healthcare community and are the basics of what we were all taught in professional school. You should include those findings.
When reviewing orthopedic testing, you should include the name of the test, whether it was positive or negative, how the test was performed and the significance of the test, if positive. Remember, the lawyer did not go to medical or chiropractic school and, therefore, has no background knowledge regarding the testing. It is also very difficult for the lawyer to find out about the orthopedic testing unless he/she has an orthopedic textbook. This information isn’t something that is readily available in dictionaries.
You should include all specialists’ findings by simply listing their diagnoses and attaching their reports to your narrative as a service to the lawyers. Regarding your care, list how many treatments were rendered and the dates of all evaluations. Attach to the narrative a copy of your SOAP notes and all of your evaluations. It is not important to get into the specific care you rendered or why you rendered that care.
When it comes to medical-legal narratives, the care isn’t important. The permanent bodily injury and the persistent functional loss is the key to an outstanding narrative. Everything else is just “fluff” that will give you a negative reputation in the legal community.
Almost 100% of the legal community only reads the conclusion in your narratives, as reported to me by over 100,000 lawyers that I have personally lectured to. Therefore, your conclusion had best be outstanding. You must tie in the history, bodily injury and persistent functional loss. Use the patient’s own words when describing the personal, social and work loss, as explained in a previous consultation. The last paragraph should be a statement about the accident being the competent producing cause of the patient’s injuries and there should be an original signature.
Make 3 copies for the lawyer, including one for the courts and one for the lawyer’s esteemed opponent. I made it a habit to either hand deliver the report or to meet over breakfast to review the report and see if the lawyer had any specific language he/she wanted used. As always, a finding was NEVER changed, but I was always amenable to changing the language if the lawyer felt it didn’t articulate the findings in a clear and concise manner.