"Providing Causality in Deposition"
Quickie Podcast 1192
Testifying 21 T
Preamble: Many of the issues I bring to you are very small, yet each issue is just that, an issue. If you take care of the small issues, then you will be able to build and more importantly, focus on the bigger issues...a larger practice and more family time. -Mark Studin 2006
"Providing Causality in Deposition"
Dr Studin: what's going on?
Guest Dr: Well, the number of the positions, two things have come up. One is called seichant. And the fact that pretty much is determined by the history of the patient gives you, is that correct?
Dr Studin: you have to go by history, you can't get a police report if you want, but here's the issue. There are three areas that lawyers will win a case, causality, bodily injury, and persistent functional loss. So they're going to try to poke holes into all three of those things. And the first thing they're going to say is causation, So now you have to turn around and you have to say, history is a part of it, but I have to clinically correlate their bodily injuries and they're persistent functional loss And it's all consistent with the history and consistent meaning There's swelling in the joint, There's spasticity, if you look at an MRI there's motique changes. If you look at an X Ray, there is no bone spurs. So all of these things, if you taken the MRI course yet?
Guest Dr: yes, I have.
Dr Studin: And spinal trauma pathology and connective tissue pathology?
Guest Dr: I don't think I have
Dr Studin: that's where these things come into play. That's why when you become trauma qualified, all of those courses become interconnected. So what you've got to do is you have to look at the age dating of the herniated disc of the vertebra, of everything. There's ways to age date these things and they're going to try to knock you out of the box. So when I train you to be an expert, this now becomes a moot point, extremely moot. you know how to answer those things, but you're still lacking some of the education to be able to nail this down.
Guest Dr: In some of these cases, what happens is you don't have an MRI…
Dr Studin: you don't need an MRI. You need an X Ray.
Guest Dr: There is for example, this one case that I was telling you about happened in a parking lot. We don't even have a police report because a parking lot is a private.
Dr Studin: you don't need a police report. You need an X Ray. stop thinking like a lawyer and start thinking like a doctor. X-ray will tell you a lot. Now for me personally, every one of my patients gets x-rays, all not just trauma cases because it gives me a biomechanical pathological diagnosis. And, I'm able to determine where the primary lesion is that I'm going to treat along with ruling out pathology. But one of the that does is it helps me age date what's going on.
Guest Dr: Also, when we say what we co-relate the history, with the orthopedic tests. They always come back saying, the orthopedic test, depending on a lot of the patients give you some feedback. If they're hurt, would you know if they have pain where you lifted the leg or whatever it is, whatever tests you're doing, and that's also very subjective word.
Dr Studin: No it's not. But I do a leg race test for instance. My other hand is behind their back and I'm feeling the muscles split when I'm doing a pyramidal compression test, I'm looking for pain patients to flinch because they're in pain. I don't need them to tell me a word.
Guest Dr: so you saying the orthopedic tests I've not subjective.
Dr Studin: For me, yes, there can be a subjective part and I always like to ask, but my hand is on their body. The purpose of stressing the joint is to see if the joint is either in a pathological state or it's compressing a nerve. So if that happens, I'm going to get feedback from the body. I don't need them to tell me anything, maybe other doctors do, but I don't, it's just experience.
Guest Dr: So history for causation, just so I get a clear history is the beginning of how would the type of conversation is not the only then but we co-related We do exams and so on, but it's the history that the patient gives you…
Dr Studin: history is where you start. So then anyway you start with the history, it gives you a roadmap and then I'm pulling in emergency room records, I'm pulling in other doctor's reports, I'm pulling in clinical and pulling in imaging studies. I'm pulling out everything. Everything's going to give me a complete picture. Then with that complete picture, I can make a determination if the problem my patient presents with is causally related and with this patient, who I evaluated, who I'm testifying about, this is chorally related.
Guest Dr: with lot of the low impact accidents you have, that didn't go to the hospital. Like I said, you don't have a police report, is her says this happened versus the other person saying…
Dr Studin: no. Low impact means nothing again. you sound like an insurance company person. It's not the speed of the impact. It's the forces that are generated, when you look at speeds, that's not the arbiter and stop looking at speed is what I tell these attorneys. It's how quick does the person come to a complete stop and then no damage, rear end collision with what the person stopped. Usually that occurs in one 300th of one second. If you look at the amount of G's of force that easily excels the injury arbiter, which is why again, you need to take the accident reconstruction and maximum engineering courses.
Guest Dr: But when you have somebody in the parking lot that they are, nobody blows space and somebody bucking up a little space and they get hit.
Dr Studin: It's the same thing. if I'm going to stop sign and someone who's rolling to a stop, it doesn't stop in time and the hits the back of my car. Well it's the same thing. It's a low speed rear impact crash.
Guest Dr: These are not real render.
Dr Studin: This is so it doesn't matter, then what happened is they're torqueing instead of going flection extension. It's the same thing.