The Medical History: "Found Down, On Fire"

01 December 2011 / Medical History / Comments Off on The Medical History: "Found Down, On Fire"

“Found down on Fire?!” I asked. “Really? That was it?!” I demanded.

“Yes.”, answered The Captain, and he took another sip on his cocktail. He was calm and very comfortable in the San Diego evening. The tropical shirt on his chest was adjusted to allow more exposure to the sun as it went down over the Pacific. A small grin stole across his mustachioed face. I realized I was in the presence of a genius.

The Captain, as I call him, is arguably the best trauma surgeon in Southern California. He had done his training at L.A. County Hospital. We had just finished a discussion on the best authored medical histories of our careers. Of course he had won…and knew it.

This was several years ago now, but each time I set down to put pen on paper I think about the wisdom of this simple medical history that has withstood the test of time. In my opinion, “Found down on Fire” has no equal. It is a timeless classic in the “Medical History Hall of Fame” because it is the definition of simple and complete in its description. A little “too descriptive” according to some of my other colleagues, but no one has questioned it authority.

I wanted to use this story to underscore the significance of being short and descriptive in the medical history component of the medical legal report. I think everyone can agree that it is much easier to write a long, rambling medical introduction and avoid the discipline and energy it takes to work with economy. If we were to open a medical chart on any teaching hospital service, you would find a five page note from the medical student, a one page note from the resident physician, and a one line note from the attending physician. Why? The attending physician understands the command of the language, and how to communicate the most information with the fewest words. Sound simple? Well, it isn’t. It is not until you have written pages and pages of histories that you are prepared and qualified to write a shorter, succinct history. Like anything else, it takes time to learn what is important in a history, and what is not.

The medical history is where the whole thing starts…literally. The history is the reason that the claim is here in the first place. After years of reading, writing and thinking about the medical legal history, the best medical history is one that gives character and life to the description of the injury. The Captain impressed this upon me. To be a great history, the description of the injury must be accessible to all readers of the report, and leave no room for doubt as to the applicant’s description of the injury.

Traditionally the doctor is taught to take the history in a standard, very predictable way. When did the symptoms start? What were you doing when the symptoms started? What makes the symptoms better? What makes the symptoms worse? What other symptoms do the primary symptoms cause? How often are the symptoms present? And this standardized approach definitely has its place. But what about this?

How many reports have you read that began innocent enough, only to morph into a massive, confusing novel of epic proportions? A report that is well intended, can actually leave you frustrated and reaching for a bottle of aspirin by the fifth or twenty fifth paragraph? I have read a few of these. Actually, I have read more than a few of these.

As a doctor writing a medical legal report, my goal is pretty clear: Does this story make any medical sense? Do I believe what I am writing? Can I explain myself to the claims adjuster or the attorney who is going to pick up and read this report? If it is clear and simple enough, I won’t have to do any explaining because the report will speak for itself. This is the goal!

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