2. Why Family Doctors?

3. experts in Family Medicine

4. Why Family Doctors? experts in Family Medicine know the patient best

5. Why Family Doctors? experts in Family Medicine know the patient best jurors have family doctors and tend to relate to them well

6. Why Family Doctors? experts in Family Medicine know the patient best jurors have family doctors and tend to relate to them well experience with chronic conditions

7. In What Types of Cases?

8. chronic pain personal injury cases

9. In What Types of Cases? chronic pain personal injury cases before and after

10. In What Types of Cases? chronic pain personal injury cases before and after clarify impact of pre-existing impairments

11. In What Types of Cases? chronic pain personal injury cases before and after clarify impact of pre-existing impairments explain clinical course

12. CAUSATION

13. did the MVA cause the pts symptoms?

14. CAUSATION did the MVA cause the pts symptoms? consideration of pts prior hx

15. CAUSATION did the MVA cause the pts symptoms? consideration of pts prior hx line between pre-accident and post- accident hx is blurry

16. CAUSATION did the MVA cause the pts symptoms? consideration of pts prior hx line between pre-accident and post- accident hx is blurry accident need not be the sole or direct cause of symptoms

17. CAUSATION material contribution Supreme Court of Canada says: Where the but for test is unworkable, the courts have recognized that causation is established where the defendants negligence materially contributed to the occurrence of the injury.

18. CAUSATION positive scientific proof not required

19. CAUSATION positive scientific proof not required recognizes multifactorial nature of many conditions

20. INJURY vs. IMPAIRMENT

21. emphasis on impairment, not injury

22. INJURY vs. IMPAIRMENT emphasis on impairment, not injury no functional impairment = no case

23. INJURY vs. IMPAIRMENT emphasis on impairment, not injury no functional impairment = no case injuries heal but impairments remain, e.g. chronic pain

24. INJURY vs. IMPAIRMENT emphasis on impairment, not injury no functional impairment = no case injuries heal but impairments remain, e.g. chronic pain do impairments interfere with daily life tasks?

25. ANATOMY OF A MEDICAL- LEGAL REPORT

26. 1.Nature of document

27. medical-legal report requested by legal representative Mrs […] is a patient of this medical clinic under my care. I have been asked to provide some further information as to her level of functioning before and after the accident that she sustained on September 3 1998.

28. 2.Summary of qualifications

29. I am a qualified medical practitioner, licensed to practice in the Province of Ontario. I graduated from the University of Western Ontario Faculty of Medicine in 1993 and received my certification as a Family Practitioner from the Canadian College of Family Physicians in 1995.

30. 3. Brief summary of pts hx in your care

31. first contact Mrs. […] has been a patient of mine since July 31 1996.

32. pts past hx When I met her she was quite a functional lady with a history of Paget's disease that was under reasonable control and a previous history of several abdominal surgeries. In general though, visits to the office were over minor concerns such as upper respiratory tract infections.

33. 4.Details of event as related by pt

34. first meeting post-event On September 4 1998 Mrs […] was seen in the office the day after an accident that happened to her in a store when a rack of picture frames fell on her injuring her right shoulder.

35. own examination and findings At that time an examination was carried out and x-rays were obtained which did not show a clinical fracture.

36. list complaints and… In short any activity that involves the use of her hands and arms causes pain in the shoulder girdle area. This presents a problem for simple activities of daily living […]

37. …functional limitations This presents a problem for simple activities of daily living such as dressing and feeding and certainly has been a limitation with respect to her interaction with grandchildren. She has required a number of modifications to her home such as ergonomic aids in the kitchen and bathroom.

38. including psycho- emotional sequelae […] there has been a rather large psychological impact as well […]

39. 5.Summarize history post-event

40. Mrs […]'s visits to the office as of late have been for routine issues including another respiratory tract infection as well as more recently some dizziness for which a neurologist was consulted but to my knowledge no serious diagnosis was entertained and an MRI of the head was reported as normal.

41. 6.Opinion

42. Certainly it is clear to me that Mrs […]'s level of functioning has been quite profoundly affected by this accident and its resultant chronic pain.

43. 7.Current status and management

44. dx

45. 7.Current status and management dx further tests & tx

46. 7.Current status and management dx further tests & tx anticipated benefit of further tx

47. 7.Current status and management dx further tests & tx anticipated benefit of further tx prognosis

48. 8.Answer critical questions

49. current level of function?

50. 8.Answer critical questions current level of function? level of function pre-event?

51. 8.Answer critical questions current level of function? level of function pre-event? cause of change in level of function?

52. 8.Answer critical questions current level of function? level of function pre-event? cause of change in level of function? current status likely to change?

53. 8.Answer critical questions current level of function? level of function pre-event? cause of change in level of function? current status likely to change? limitations/restrictions on daily activities? On employability?

54. CONCLUSION Indicate that your opinions are based on:

55. CONCLUSION Indicate that your opinions are based on: – your own knowledge of pts hx

56. CONCLUSION Indicate that your opinions are based on: – your own knowledge of pts hx – pts chart, including consults

57. CONCLUSION Indicate that your opinions are based on: – your own knowledge of pts hx – pts chart, including consults – subjective complaints of pt

58. CONCLUSION Indicate that your opinions are based on: – your own knowledge of pts hx – pts chart, including consults – subjective complaints of pt – your own findings based on examinations and observations

59. CONCLUSION Qualify your opinion

60. CONCLUSION This is a final report based on the information currently available to me. Should more information become available later, it may substantiate or modify the opinions I have expressed. In that case, I would be pleased to provide an updated report should you so request.

61. DONTs

62. DONT DONT be afraid to contact the legal representative

63. DONT DONT be afraid not to provide a report

64. DONT DONT be afraid to contact the legal representative DONT DONT be afraid not to provide a report DONT DONT regurgitate your chart verbatim

65. DONT DONT be afraid to contact the legal representative DONT DONT be afraid not to provide a report DONT DONT regurgitate your chart verbatim DONT DONT advocate unless you can substantiate

66. and lastly… DONT DONT overstep the bounds of your expertise

67. Personal Injury. Malpractice. Disability. Insurance Claims. Personal Injury. Malpractice. Disability. Insurance Claims. E X P E R I E N C E. I N T E G R I T Y. www.flashlaw.ca R E S U L T S. www.flashlaw.ca