“The Paradigm Shift”
Getting the lawyer to want to meet with you and then refer
If you have not read every previous consultation, sent me your infomration for a compliance review, you need to do so prior to taking any action. If you do not, then what you think will be a very positive meeting with a lawyer stands a good chance of creating a negative reputation. That is worse than having no reputation.
You now have a few of the tools, based upon the previous 25 consultations, to meet with the lawyers and once you finish all of the ocnsultation and quickie consutlation in the fist 6 sections you will be better preprared. You will have admissible findings, an admissable, robust curriculum vitae and demonstrative documentation that will clearly outline what’s needed by the lawyer to prevail in an ethical fashion. The only thing left is to get them to want to meet with you and then communicate effectively all of the above. The communication should be both verbal and written to back up the language at the meeting.
The easy part is usually the talking and the hard part is the demonstrative evidence that will allow the lawyer to prevail. No more…It’s time to deliver what you have created. Your paperwork IS THE BEST IN THE NATION. That is not my opinion; it is the opinion of 100,000 plus lawyers that I have lectured to.
In order for this to work, your curriculum vitae and documentation must be in the correct format. I have been asking to see yours and if I have done a complaince review, be prepared to be successful. Remember, the format for the narrative was created by 1000’s of the brightest personal injury lawyers in the country. I am just a good listener.
ALSO: There is no ONE MAGIC BULLET that will get you where you want to go, it is a compilation of everything and takes time and perseverence. However, the end results are deeply rewarding.
Regarding your relationship with the lawyers, in the beginning you need them more, as you need their patients to treat. Once you have their patients under your care, the lawyer will need you more, as it’s your paperwork that will allow him/her to prevail in his/her cases. This is called leverage and it’s the best mechanism to have the lawyer want to meet with you.
You must identify the patients that have current personal injury cases within your practice…from the lawyer’s perspective. In virtually every state, it takes the lawyer approximately 18 months to settle his/her cases (except NY…it takes much longer…Lucky us New Yorkers).
Once those patients are identified, you must review every chart to see if you have all of the information required for a final narrative. The most revealing absence is usually the persistent functional loss…in living color. The personal, social and work limitations have been explained in the previous consultations.
If your records are deficient in fully describing functional loss, you must call the patient and have a conversation with him/her, asking him/her to describe what persistent losses are present. Should a patient not want to take the time to go over this with you, remind him/her that what he/she gives to you, you in turn give to his/her lawyer and can greatly impact the case. Make sure that he/she is very detailed in explaining what he/she is experiencing. This paradigm shift with the patient will get him/her to give you detailed information.
If the patient's functional losses are clinically consistent with his/her injuries, then create a final narrative. If they aren’t, ask the him/her to come into the office for a final examination to see why the symptoms don’t clinically correlate to the current history.
Do not associate symptoms with subluxation if they are significant. You must have objective findings, preferably visual findings, to document why. This is called a diagnostic dilemma. Why are there persistent findings?
In 1993, I was the proud recipient of 2 compression fractures at T11-T12 and was on the floor in pain for quite some time. I consulted a neurosurgeon who gave me the best advice I have ever gotten regarding treating the injured. He said, “My job is not to assess your pain because everyone perceives pain differently. Therefore, my job is to determine the pathological cause of your pain.”
That lesson was well taught and now when I speak to any patient, especially trauma patients, I listen to their symptoms and then use that as a starting point to diagnose why and where. As a result of my own experience, I have become a very aggressive diagnostician, as well as a passionate healer. I will not be comfortable with a patient’s symptoms unless I have verified objective proof of the why, the pathological cause of their pain.
Do I do this for the lawyer or the case? No! Truthfully, IDGARA (I don’t give a rat’s ass - please forgive the transgression) about the lawyers case…I want to make sure that I have not missed any pathology that will change my diagnosis, prognosis or treatment plan. I want to know the results immediately and do not want to, nor should I, wait.
Your decision to do any additional testing with these is based upon one thing and nothing else, clinical necessity. When you are speaking to the patient about his/her persistent functional loss and then decide that your last examination did not give you the reasons for his/her current symptoms, get the patient back into the office and do another examination. It is then that you need to make the clinical decision to order additional tests based upon the examination results. Whether it be additional x-rays, MRI’s or EMG’s, you must document why you made that clinical decision and have the patient go for whatever tests are necessary until the clinical dilemma is answered. Once all clinical dilemmas are answered and you are certain that no additional treatment will be beneficial, you can then write a final narrative and certify that the problems are permanent in your report.
In meeting with the lawyer, you need to create a portfolio to give him/her. In this portfolio, place your CV on ivory parchment type paper with black ink. The reason you use ivory parchment is in the legal community, the lawyers use that medium for their important correspondence. Align yourself to what they already perceive as conservative professionalism. Then take all of the bi-monthly educational fliers and customize them. If you notice, in the fliers, I try to leave the bottom blank. This is done for the very specific reason of allowing you to customize each one for this purpose. The document is not write protected. This means that I am exposed to others using my material without permission, but it also means that it gives you the ability to add any information that you want to market your practice. In this forum, it is permissible and advisable to solicit. You should add your clinic name, doctors' names, hours, services, etc. Include any information that will, in a conservative, professional manner, help the lawyer understand that you can meet their needs.
DO NOT…list yourself as a “family”, “nutritional” or “wellness” practice. Doing so will not help the lawyers prevail in their cases and will probably influence them not to send you any patients. This ties into their experience with family MD’s. They are the least capable healthcare providers for a trauma case, as they are mostly clueless in treating and documenting the injured. The lawyer has had a lifetime of frustration in dealing with these practitioners and you do not want to align yourself with them on paper.
Take the bi-monthly educational fliers and print them after you have customized them. 3-hole punch them so you canput them in a portfolio or 3-ring binder with a very professional cover. This way, as the weeks go by, you have a reason to stay in touch with the lawyer and add to their binders with additional fliers that I create for you every other week. In this binder, you have your CV and the bi-monthly educatinal fliers. You then have either the patient’s narrative that is stapled (not in the binder) and printed on ivory paper or a sample narrative in a separate portfolio that has the sheets laminated. You do not give a lawyer the sample narrative.
One thing I like to do with new lawyers is not prepare the actual narrative for this meeting. Instead, I will show them the sample narrative and then ask them if the format is good for them. By the way…it is. I inform them that I will make any changes they want in format, provided the results do not change. Most will ask you for a copy of the sample (they will want to show it to their current relationships to have them emulate it) and you need to respectfully decline. Tell them they can have a copy when you give them their client’s report. THERE ARE NO EXCEPTIONS…DO NOT GIVE THEM A COPY OF THE SAMPLE AS THEY WILL BYPASS YOU IN THE FUTURE ONCE THEY HAVE YOUR FORMAT.
Once you have everything prepared, call the lawyer and tell him/her that you have significant information regarding the client and need to meet, preferably for a brief breakfast meeting. Many will simply ask for you to send them the information. Be persistent. Insist on a brief meeting and most will acquiesce and meet with you.
At the meeting, schmooze with the lawyer (of course) and make sure you touch on all of the admissibility topics, exams, x-rays, MRI’s, specialists and the big one….persistent functional loss in real life terms that clinically correlates to functional loss. At the meeting, it is important to understand that you will not have every answer for the lawyer. He/She will ask you technical, medical questions about his/her other clients in order to gauge your knowledge and ability to communicate. I often do not have the answers at the meeting. No one is expected to know everything. Many times during a meeting, I picked up my phone and called an orthopedic surgeon, neuroradiologist or neurosurgeon and got the answer immediately. Other times I told the lawyer I would get back to him/her later in the day with the answer and I did. It is okay not to have the answer!
Feel free to call me while you are at the meeting. As I have done so many of these breakfast meetings, there aren’t many questions I can’t answer. It is perfectly acceptable for me to be your expert and either ask me the question or put me on the phone with the attorney. If you have any anxiety about the meeting, contact me beforehand and I will work to make myself available during the time of your meeting.
Guide the conversation to the chronology of symptomatology, also explained in a previous consultation, so they understand that they do not want a narrative report the second a patient finishes active care. Finish off the meeting with an explanation about the PIME…Plaintiff Independent Medical Examination. At this point in time, you should have gained the lawyer's confidence that you know what is needed in an ethical fashion.
Once the lawyer knows that you speak his/her language, he/she will want to continue to work with you and refer both new patients and patients of other doctors to you for the PIME. Of those PIME patients, it’s my experience that many will also switch to your care. Do not be timid in asking for PIME patients. This exam is for their benefit and you are not asking for the patient to start as your patient. Explain that once you do a PIME, the lawyer will get this type of quality report for each one.
As a side note, I charged $450 for a PIME that did not start care and it included the narrative. (Orthopedists, neurosurgeons and neurologists historically charge $1000 for the same service…You set your fee as you see fit.) The only exception is some no-fault states that set the fees for you. In those states, follow the prevailing fee schedule.
- To get started, make sure that I have critiqued you CV and narrative.
- McGriddles are not an accepted form of breakfast.
- Pick a “hip” place for breakfast; every community has one.
- Pay for breakfast and tip big, they look.
- Dress should be business casual. Look the part.
- Make sure you talk about the lawyer; where he/she went to school, where he/she grew up, his/her frustrations with the insurance companies (this is a big one).
- Be prepared with all of your material. Remember the 6 P’s:
When you have completed your meeting, I would like your feedback in an e-mail, telephone call or testimonial.