• Keys to Success for Chart Reviews

    08 July 2012 / Chart Reviews / Comments Off on Keys to Success for Chart Reviews

    In the following, I will provide my experiences on how to be successful in reviewing the medical record chart. I will explain how to avoid frustration.

    There are many subtleties to the chart review that may be easily overlooked. Mental preparation is an essential key to success. No one likes to receive an organized stack of papers.

    Check your emotion before you begin the chart review process, because you will find your ability to be open to the information may be subconsciously impacted. You must have a method to approach the task. The approach has to be deliberate and focused.

    When performing the medical legal exam there may be no medical documents available at all. Records that are available may vary greatly in quality. The notes may be third generation photocopies, hand written office visits, or even small post it notes included in the chart from ancillary staff.

    All of this must be analyzed for significance and value.

  • Medications in a Legal Medical History Report

    05 July 2012 / Medical History / Comments Off on Medications in a Legal Medical History Report

    Medications may be one of the areas most often overlooked in the medical legal report, which is interesting because they make up a significant portion of the overall cost of health care dollars on an ongoing basis. In addition, to being expensive, medications can also result in serious side effects and problems. These two concepts together can equal a big deal.

    Most applicants, you will find, consider over the counter medications to not be “medications”. If you use a question intake sheet and do first visit injury care, you understand what I mean. Often the section on medications used for this injury is blank.

    On closer questions, however, you will discover that when you are outlining a treatment plan, the applicant will often say, “No, I used that already” in reference to Motrin, Tylenol and some of the more common over the counter pain preparations.

    So when opening the discussion about medications, clarify that over the counter medications do count as “medications”. This also included any “supplements’ or “vitamins” they have purchased with the intent to treat their pain or symptoms.

  • Three Basic Goals for The Chart Review

    03 July 2012 / Chart Reviews / Comments Off on Three Basic Goals for The Chart Review

    Medical document review holds three basic goals.

    The first goal is an overview of what evaluations, diagnoses, physical exams, and response to treatments have been documented.

    Next, is an opportunity to review the diagnostic work up.

    Finally, critical pieces of information are gathered to help support the opinions and conclusions I will draw in the discussion of the report. These are the essential functions of the chart view.

  • Every Good Story Has An Ending

    27 June 2012 / Medical History / Comments Off on Every Good Story Has An Ending

    You have put a lot of effort into writing a careful history, but how does the history end? How was it at the end of the day, that the applicant ended up in your office? Was the applicant required to attend this visit by the adjuster, or an attorney? Were they unhappy with prior medical care? If yes, why?

    Think about this section of the history as the “Exit Interview” of the applicant. If you are still unclear as to how they got here, ask more questions. I always table these questions as an opportunity for the applicant to “let us hear your side”.

    You will find that much of the emotional tone of the claim can be found at the close of the interview if done correctly, but it will require a conscious effort. You will have to do some reading between the lines at times, but it will give your history that added flavor for the reader that will set your report apart from all of the others.

  • My Favorite Reference on Medical Legal Report Writing

    24 June 2012 / Chart Reviews / Comments Off on My Favorite Reference on Medical Legal Report Writing

    There is an excellent textbook written by SEAK, Inc., Writing and Defending Your IME Report, The Comprehensive Guide by Steven Babitsky, Esq, James J. Mangraviti, Jr., Esq, and J. Mark Melhorn, MD.

    If you're going to write medical legal reports on a regular basis, I cannot recommend this book strongly enough.

    The text serves as a comprehensive guide in considering the appearance and organization of your medical legal report. The book coaches on the use of active language, deposition types of situations you may face. At gives very useful examples on how to format the chart review section of the report.

  • Make a Time Line for Taking a Great Medical Legal History

    20 June 2012 / Medical History / Comments Off on Make a Time Line for Taking a Great Medical Legal History

    This is really simple and works like a charm.

    For claims that are several years in duration, involve derivative compensatory injuries, or serial dates of injury you need to reach for the Sharpie pen. Step aside, pull out a fresh section of exam table paper, and let the applicant get down to work. You will be amazed.

    I learned this the hard way after many frustrating attempts to do a straight verbal interview under these circumstances. Most of us connect our histories to holidays, seasons of the year, birthdays, graduations, etc. A calendar on the wall doesn’t hurt either.

    In fact, step outside for a few moments and let the applicant do the work for you. The time line is an excellent tool to frame the history in a complex case. This will also keep your dictation focused and moving forward when it is time to write.

  • Did I Miss This Day in Medical School?

    17 June 2012 / Chart Reviews / Comments Off on Did I Miss This Day in Medical School?

    Did I miss this day in medical school? Very little is formally written about the process of chart review.

    I can't recall any formal teaching, critique, or mentoring either in medical school or residency with reference to chart review skill. Chart review is a critical part of the medical legal report, yet probably the most underdeveloped talent in doctors. Style varies greatly between medical providers. Very little, if anything is written describing this important event in the medical legal report.

    The question then really becomes, "What purpose does in medical chart review really serve, and who does it serve?”

    Remember, these findings will serve as the third foundation for the report, following only the history and the physical exam/imaging. A well-written chart review will be informative and brief. This is an opportunity to set your report apart from all others that have come before.

  • Accurate and Simple Medical Legal History

    14 June 2012 / Medical History / Comments Off on Accurate and Simple Medical Legal History

    Doctors: Limit the injury or illness to a single idea, and check your story from several angles.

    Phil Walker, Esq.Don’t get fancy with the words or the details. Remember, take your time and invest the effort to produce an accurate and simple story. It may take some time, and it may be a little frustrating for everyone at first, but chisel away until you have a crystal clear picture in your head about what this person before you is trying to say. Repeat it back, several times, place yourself in their situation, then ask for the answers you expect to hear.

    For example, “So you said your ankle popped, immediately swelled to the size of a grapefruit, and the foot went numb? I would think I might want to see a doctor immediately and tell someone at work…what did you do?”

    Remember, the applicant is not being cross examined in a murder trial. We only want a story that validates common sense of the reader.

  • Taking a Great Medical Legal History

    12 June 2012 / Medical History / Comments Off on Taking a Great Medical Legal History

    Phil Walker, Esq.

    Doctors: Ask questions using language that is easy for patients to understand.

    There is an excellent medical manual called DeGowin & DeGowin's Bedside Diagnostic Examination. In this book, there is a fascinating bit of trivia I think about when interviewing applicants. The book states that the average adult has about 100,000 words in their vocabulary. After medical school, the vocabulary triples to 300,000. This increased vocabulary actually becomes a handicap because it places distance and increases the chances of miscommunication between the doctor and the applicant.

    The applicant may not feel comfortable asking the physician to re-state the question, or explain certain words they do not understand. The result here is two very negative consequences.

    The first consequence is incorrect answers, which means an incorrect history. The second consequence is an applicant that is embarrassed and leaves the interview feeling they were not able to tell their story.

    Think carefully about the language you choose.

  • Residency and Beyond

    07 June 2012 / Impairment Rating Specialists / Comments Off on Residency and Beyond

    Dr. John AlchemyUpon completion of residency I learned something very important. The kind of thing you can only learn looking back, after having completed the experience.

     

    The lesson was this: In the early stages of exploring a specialty of medicine, even as a doctor, it is nearly impossible to separate our opinions of a specialty from the teachers who are teaching us. For example, a very enthusiastic instructor can make boring and dry topics come to life based on presentation and emphasis of the material.

     

    By telling stories, making connections, and pointing out the recurring themes of practice that weaves the patient and the medicine together, it is very easy to confuse the subject with the instructor. It is kind of like clothing. Some colors and styles compliment people in very unique ways. Try that same clothing on yourself, take a look in the mirror, and you say.. “maybe not so much”, or if you are lucky you will say, “Yep, this is exactly my size. Time to go to checkout!” That is the summary of trying to pick your specialty in medicine.

     

    It was 1997, when I finally found the suit that fit me in that mirror. I was taking an elective rotation in Occupational Medicine. I stumbled into the rotation when I was looking for a practice setting that had a combination of urgent care medicine, with continuity of care follow up visits. I still remember putting together my first two weeks of discovery on that rotation. Here I am, able to focus on a single set of problems, in an urgent care setting, with cases that had something I had never imagined existed….an administrative end!! How was this? It was amazing!

     

    These occupational medicine cases actually had a beginning, a middle and an end. Then it got even more amazing (like the advertising for the set of steak knives that can cut through the hood of a 1957 Buick, then effortlessly cut a freshly baked loaf of bread with laser precision). There was the language. I was intrigued with the language, and the endless definitions.

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