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MEDICOLEGAL NOTHING TO DISCLOSE. BAGNALL’S MAXIM POWERPOINT IS THE VIAGRA OF PUBLIC SPEAKING DISCLOSURE: I HAVE NO INTEREST, WHATSOEVER, IN VIAGRA……….EVER!!

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Presentation on theme: "MEDICOLEGAL NOTHING TO DISCLOSE. BAGNALL’S MAXIM POWERPOINT IS THE VIAGRA OF PUBLIC SPEAKING DISCLOSURE: I HAVE NO INTEREST, WHATSOEVER, IN VIAGRA……….EVER!!"— Presentation transcript:

1 MEDICOLEGAL NOTHING TO DISCLOSE

2 BAGNALL’S MAXIM POWERPOINT IS THE VIAGRA OF PUBLIC SPEAKING DISCLOSURE: I HAVE NO INTEREST, WHATSOEVER, IN VIAGRA……….EVER!!

3 WHO AM I? PRIVATE OUTPATIENT MSK/INTERVENTIONAL PAIN PRACTICE FOR 24 YEARS AAPM&R BOG/ACADEMY WORK TEACH AT THE LOCAL MEDICAL SCHOOL STARTED MEDICOLEGAL WORK 24 YEARS AGO MY FIRST EMPLOYER OUT OF RESIDENCY INTRODUCED ME TO PI CHART REVIEWS….IME’S/DEPS FOLLOWED PI: LOCAL DOCTOR RUN REFERRAL SERVICE WCI: TREATED PATIENTS, IME’S FOLLOWED

4 PHYSIATRISTS & MEDICOLEGAL WE ARE THE PERFECT DOCS FOR THIS WORK WE SEE THE WHOLE PERSON, MANY DISCIPLINES UNDER OUR UMBRELLA OF EXPERTISE, SYNTHESIZING MULTIPLE DATA POINTS (MULTISYSTEM) WE KNOW HOW TO AVOID UNNECESSARY INTERVENTION & (SHOULD) KNOW THE CORRESPONDING LITERATURE WE ARE DISABILITY/ABILITY SPECIALISTS

5 THE PI ARENA WHAT IS PI? CHART REVIEW VS OCCASIONAL IME RULES OF EXPERT TRANSPARENCY DISCOVERY DEPOSITION EVIDENCE DEPOSITION BINDING ARBITRATION VS OCC TRIAL MANY SETTLE

6 THE WCI ARENA WHAT IS WCI? LAWS DIFFERENT (PAIN/SUFFERING) ARBITRATOR/EV DEP TREATED THESE PATIENTS MET THE NCM’S ADJUSTORS HEARD OF/LIKED ME (?) TREATED THE NCM’S, ADJUSTORS &/OR FAMILY

7 DISABILITY ARENA NON-SSDI EVALS MAY HAVE CONCURRENT SSDI USUALLY DISABILITY INSURANCE COMPANY EVAL (DEFENSE) VS ATTY REQUESTED (PLAINTIFF) OFTEN NO ATTY INVOLVED INJURY LITIGATION OFTEN N/A OR SETTLED

8 MEDICAL MALPRACTICE ARENA MESSY CAN’T AFFORD ME PLAINTIFF OPINION WORK UNTIL……

9 HOW TO BE A GOOD EXAMINER HAVE AN OPINION (TF) TESTIFY WELL (GET YOUR INTENT ACROSS & HAVE FACTUAL SUPPORT) TRY TO DO PLAINTIFF AND DEFENSE CASES GIVE THE PATIENT BENEFIT OF THE DOUBT DO NOT CHANGE AN IME REPORT…ADDEND TELL THE TRUTH, BE HONEST I’VE LOST BUSINESS FINDING MISSED PATHOLOGY

10 IME STANDARDS SCHOFFERMAN J. PAIN MED MAY- JUN;8(4): MARTELL MF, ET AL. PHYS MED REHABIL CLIN N AM AUG;12(3): RICH BA. PAIN MED SEP-OCT;7(5):460-3 BAL S. CLIN ORTHOP RELAT RES. FEB 2009;467(2): KLEE CH. NEUROREHABILITATION. 2001;16(2):79-85

11 IME STANDARDS (CONT.) REPORT TO AMA BOARD OF TRUSTEES, B OF T REPORT 5-A-98 AMA “GUIDES NEWSLETTER” NOVEMBER/DECEMBER 2005 EDITION resources/medical-ethics/code-medical- ethics/opinion907.page resources/medical-ethics/code-medical- ethics/opinion907.page s/publications/4913.pdf s/publications/4913.pdf

12 MARKETING

13 MARKETING TO WCI SYMPOSIA (CME?) SEMINARS/SPEAK AT NCM ASSOCIATIONS (RING) SEMINARS/SPEAK TO ADJUSTORS SEMINARS/SPEAK TO SPECIAL INVESTIGATIVE UNITS OF INSURANCE COMPANIES DO A GOOD JOB!

14 WCI CASE MANAGERS GIVE THEM A ROOM & A PHONE AFTER AN IME MEET THEM & DICTATE IN THEIR PRESENCE ANSWER THEIR QUESTIONS HAVE AN OPINION GIVE SPECIFIC RESTRICTIONS REPORT PROMPTLY BE AVAILABLE FOR APPOINTMENTS/CALLS

15 MARKETING TO PI I DON’T….PERIOD LISTS (PAID VS FREE) LISTING/REFERRAL COMPANIES ADS ABIME, AADEP CERTIFICATIONS (INCLUDING ACRONYMS AFTER YOUR NAME) IICLE TALKS

16 ACTUAL IME REPORT “THIS GENTLEMAN HAS AN EXCESSIVELY NONORGANIC EVALUATION, AS LISTED ABOVE. HE HAS MULTIPLE BIZARRE COMPLAINTS THROUGHOUT THE ENTIRE BODY, WHICH MAKE LITTLE, IF ANY, MEDICAL SENSE AND ARE NOT OBJECTIVELY SUPPORTED.”

17 PAIN DIAGRAM

18 IME REPORT (CONT) “NONE OF HIS TREATERS HAVE ACTUALLY GIVEN HIM ANY MEDICAL DIAGNOSIS OF ANY SIGNFICANCE. HE IS NOT A CANDIDATE FOR ANY FURTHER TREATMENT OR TESTING RELATING TO THESE COMPLAINTS.”

19 TESTIMONY GOALS DISCOVERY: FIND OUT THE FACTS IN THE CASE EVIDENCE: PRESENT THE EVIDENCE IN THE CASE TO A JUDGE, JURY OR ARBITRATOR/S IMPEACHMENT ATTEMPTS OPPOSING ATTY WILL ATTEMPT TO DISPROVE OR DISCREDIT YOUR OPINIONS &/OR YOUR QUALIFICATIONS DAUBERT STANDARD MET

20 TESTIFYING WELL LISTEN TO THE QUESTION: SINCE YOU SAID THE PATIENT IS RIGHT HANDED, DOES THAT MEAN…..? ANTICIPATE EXACTLY WHAT THE ATTY WANTS TO KNOW BY ASKING THE QUESTION TRY TO ANTICIPATE THE NEXT QUESTION HYPOTHETICALS: IS IT POSSIBLE THAT A FAIRY SPRINKLED DUST ON THE PT WHILE THEY SLEPT? HOW MUCH ARE THEY PAYING YOU FOR YOUR OPINION TODAY?

21 TESTIFYING WELL (CONT.) A GOOD WITNESS MUST HAVE CONFIDENCE & FIRM BOUNDARIES DO NOT THEORIZE: IS THE PATIENT HAVING PAIN? DO NOT OVEREXTEND: DENTAL WORK, PSYCH BE CONSISTENT (PRIOR TESTIMONY IS OUT THERE) THIS IS NOT A CONVERSATION (BULLYING) YOU CAN OBJECT TO A QUESTION! IF YOU TEACH, YOU CAN TESTIFY

22 BUSINESS OF DOING BUSINESS NO SHOW/LATE CANCELATION OF IME=FULL CHARGE I BILL IME’S PER BODY PART, PER INJURY, EXTRA FOR COPIOUS RECORDS TRAVEL TIME MAY BE BILLED (PORTAL TO PORTAL)

23 BUSINESS OF DOING BUSINESS (CONT.) 2 HR DEP MINIMUM, NOT COUNTING PREP TIME DEP CANCELATION=1 WEEK IN ADVANCE, GET DEPOSIT UP FRONT ALWAYS GET PAYMENT UP FRONT…ALWAYS

24 DID I MENTION? ALWAYS ALWAYS

25 DID I HAVE AN OPINION?

26 IS SURGEON IN A BETTER POSITION?DISCREDITED?

27 AM I A PSYCHOLOGIST? DISQUALIFICATION ?

28 IS HE A MALINGERER? OVEREXTENSION?

29 DON’T DO MEDICOLEGAL IF: CAN’T ARTICULATE WELL DURING TESTIMONY CAN’T BACK UP ARGUMENTS WELL WITH RELEVANT EVIDENCE BASED STUDIES DON’T FEEL COMFORTABLE WITH TAKING ON DOCTORS WITH DIFFERING OPINIONS CAN’T TAKE THE HEAT OF UNHAPPY PATIENTS (RATINGS) CAN’T BE DECISIVE WITH DIFFICULT OPINIONS/RECOMMENDATIONS

30 DON’T DO MEDICOLEGAL IF (CONT.): CAN’T BE PROMPT WITH (LONG) REPORTS ARE BAD/INFLEXIBLE WITH DEADLINES CAN’T BE AVAILABLE FOR SCHEDULING OF IME’S, DEPOSITIONS CAN’T GET TO RECORD REVIEWS PROMPTLY ARE NONCONFRONTATIONAL DON’T LIKE TALKING TO LAWYERS

31 DESTINATION: TENACATITA


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