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Pain-free medico-legal reports
Taking the edge off a tedious task
an interview with Michael Zitney,
MD
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Why do reports
have a bad rap?
Most physicians don't write medico-legal reports on a regular basis,
so they aren't sure what to include. Often, they also don't know
how the report will be used. They leave the task of writing until
they get two or three gentle reminders from the lawyer. By then,
the report is bound to be rushed, and as a result is likely to be
poorly written and not very useful. This is an unfortunate chain
of events, as good reports help to settle cases and improve your
chances of not having to testify at a trial.
What types
of medico-legal reports are there?
As a general practitioner, you're most likely to be asked to write
a report about a patient of yours, someone you know well and have
treated for a long time. Alternatively, you may be asked to perform
an assessment and provide a report on a person you've never seen
before. Usually, this type of request is directed at a specialist
in a specific area of medicine -- it's called an Independent Medical
Examination (IME).
As only one side (typically the insurance
company) pays for the report, you should take extra care to maintain
a truly independent viewpoint. You write the report based on your
findings, and you'll be asked to draw conclusions. When doing an
IME, ask for all the medical information the requesting person has.
This will help inform your conclusions and prevent surprises while
on the witness stand if asked to testify.
There are other obligations inherent in performing
an IME. According to the College of Physicians and Surgeons of Ontario,
patients may not be familiar with the type of relationship they
will have with someone carrying out such an examination. So you
should be extra cautious in explaining the purpose of the assessment,
how it will be performed, what body systems will be involved, what
other tests may be required, where the report will be sent and how
you will be paid. Make sure the patient understands that the report
you write will be based on the examination and/or interview, any
observations made during the meeting as well as other medical reports
received. It's also important that the person is aware that no treatment
or medication prescriptions will result from this assessment. You
should document this discussion, as well as the times you start
and finish the assessment.
How do I
get started?
No matter what type of report you're doing, you must have consent
from the patient in writing -- not just verbal -- to release their
medical information. At the time of writing, you should have all
the patient's information in front of you. Give yourself ample time
-- don't leave reports to the last minute. Ontario College regulations
require that you respond to requests for reports "within 60 days,
unless other arrangements are made." Designate one day each month
to catch up on writing.
Try to determine how the report will be used.
The legal team is likely to have a strategy that they think will
help the patient, and they're looking for medical evidence to convince
the decision-maker (judge or arbitrator) that their side of the
case is the most reasonable. Your medico-legal report will be of
best use if there's communication between you and the legal team
before you start writing. Get clear instructions and a list of questions
from the lawyer. A verbal explanation of what's expected can also
be helpful.
What if I
can't write a favourable report?
If I suspect that my report will be detrimental to the lawyer's
case, I try to discuss this before writing -- and I make sure not
to leave this discussion until the last minute. The lawyer may decide
to ask a different set of questions, or not to request the report
at all. Be aware, however, that the patient's chart is usually entered
into evidence and is made available to both legal teams.
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