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Our Services

Interpretation of Medical Records & Reports

Medical Summary Reports

IME Observation and Rebuttal Reports

Medical Research to Answer Specific Case Questions

Liaison with Treating Doctors

Medical Record Reviews

Question Preparation for Depositions and Testimony

Referral to Appropriate Medical Experts

Liaison with Service & Government Agencies

Independent Medical Examinations

Medical Expert Testimony / Depositions

Medical Malpractice (Defense only)

The Weaknesses and Strengths of the Medical Chart Review

The treating physician and the physician hired to review medical records both have important and differing perspectives in a case.

The main advantage of the treating physician is that he may have examined and evaluated the patient during many critical events.

The disadvantage of the treating physician’s opinion is the bias of the personal connection with the patient.

The advantage of the reviewing physician viewpoint is his ability to devote a greater amount of time to the analysis and research of the case, potentially greater expertise and knowledge of the standard of care, usually greater access to records, and, most importantly, objectivity.

Medical record review is often necessary during the course of litigation. This review is subject to many strengths, weaknesses, and biases, as is pointed out in nearly every disposition by the opposing counsel.

The most glaring is that the reviewing physician is not treating physician. The reviewing physician usually has never examined the subject. He certainly has never examined the subject in the critical time during which the incident in question occurred, He is limited to the documentation that has been supplied in obtaining his information. This documentation is usually incomplete, poorly crafted, and often cursory. This disadvantage cannot be denied.

However, the reviewing physician has a number of advantages over the treating physician which can make his opinion critical to the successful resolution of the case. First and foremost is that the reviewing physician has access to a larger wealth of documentation. Of course this is only an advantage if the entire record and all supporting documentation is given to the reviewing physician. It is very uncommon for most treating physicians, especially specialists, to receive much in the way of documentation at the beginning of treatment. If it is supplied, the physician usually does not devote the time necessary to carefully analyze it. The treating physician is therefore usually limited to the oral history the subject provides during the treatment. This can be biased significantly by what the subject believes that the physician wants to hear, and by the impressions that the subject wishes to give his physician. Many times the background medical information can be critical in determining many aspects of the case.

A second great advantage is that the reviewing physician is not as limited in terms of the time that he can spend on the case. Where most treating physicians are limited to 5 to 15 min. of time that they can get to each patient during an appointment, a reviewing physician must meticulously evaluate the documentation, research, and analyze the case to render an expert and informed opinion of the case.

The third and final advantage of the reviewing physician is objectivity. A treating physician should and usually is an advocate for their patient. Often the relationship that forms between the treating physician and the patient clouds the medical opinions rendered. In many cases which involve litigation and insurance questions, the medical treatment has not been completely successful. Feelings of guilt and fear of malpractice may also be a very real motivation in distorting a treating physician’s medical opinion. Although the desire to please the attorney hiring them may also affect the reviewing physician’s opinion, most experienced physician consultants understand that biases and misrepresentation of the record, medical fact, and standard of care will severely damage the hiring attorney’s case, possibly disqualify him as a medical expert, and potentially irrevocably harm the reputation of the physician within the community. More importantly, it is unethical and unfair. This goes against the basic instinct of most physicians, and, believe it or not, the medical profession still attracts people to whom this is very important.

While, in medical-legal analysis and legal proceedings, a physician reviewer of the medical record has some limitations, their opinion and analysis of the case can be instrumental in clarifying the facts. He can help to assist both attorneys and lay persons in understanding the legal facets of potentially complicated medical situations so that an informed and fair decision can be made in an efficient manner. Their ability to serve in this function depends on being supplied with complete records, approaching the case in an objective and even-handed fashion, and disclosing all relevant medical facts, research, and accepted opinion. Ideally, this allows the parties involved in the litigation to find common ground and settle a case without a formal trial. At Indiana Medical Consulting, we guarantee objective evaluation, meticulous review, and evidence-base opinion and conclusion in a timely and economical fashion.

Reading between the Lines: Primary Care Physician’s Record

Documentation from the primary care physician can be extremely helpful in medical record review.

The frequency and regularity with which a subject uses the services of their primary care physician can help establish their threshold for medical treatment and can shed light on many aspects of the subject in unexpected and useful ways.

Various medications that are used in the treatment of pain may be documented in the primary care physician’s notes.

The identification of other medical problems, difficulties or conflicts during treatment may change the context of the events more central to the litigation.

Medical record review and analysis can be straightforward. However in other cases, more subtle clues must be included in order to get a full picture of the case. In order to get the most information possible from the record, the reviewer must read between the lines. I have found that one of the most useful parts of the medical record are notes from the subject’s primary care physician. Although it is not immediately obvious, among the PAP smears and flu shots, this document gives great insight into many aspects of the subject’s medical condition and attitudes towards medical treatment especially if the records cover a significant period of time.

Since many cases that involve litigation are centered around pain, it is helpful to determine whether many of the conditions that are commonly associated with the development of pain syndromes are present. Associated medical conditions and diagnoses that are commonly found with pain syndromes are dysmenorrhea, irritable bowel syndrome, neuropathy, hypoglycemia, chronic fatigue syndrome, fibromyalgia, and migraine and other headache syndromes. It is also helpful to note other areas of musculoskeletal pain that have occurred. Subjects with poorly defined pain in the neck and shoulder that has proven difficult to diagnose and treat are also the subjects that are likely to develop back and lower extremity pains after trivial injuries. In addition, other markers that predispose someone to pain include psychiatric disturbances, multiple drug allergies and environmental sensitivities.

With the advent of more strict documentation requirements, many primary care physician’s notes often regularly delineate the current medications at each visit. This is helpful in determining whether pain medications such as narcotics, nonsteroidal anti-inflammatory medications, and other agents such as gabapentin, duloxetine, pregabalin, tramadol, and antidepressants are being used to treat pre-existing painful problems.

The method in which a subject uses general medical services can give some idea about the threshold that is necessary for them to see a doctor. According to a recent CDC study, the average American sees their primary care doctor 1.6 times per year, goes to the emergency room 0.5 times per year, and sees a physician of any specialty about 4 times per year. A subject who sees their primary care doctor significantly more than this either has physical problems that require intensive management or has a low threshold for medical evaluation. This may be useful information in the context of their litigation injury and the documentation associated directly with this.

Finally, medical conditions that may alter mental status or interfere with the performance of various tasks may be important to identify to determine the subject’s involvement or culpability in the litigation. Many common medications have psychoactive properties including agents used to treat stomach ulcers, pain, depression and seizures and can cause unpredictable changes in mood, attention, and mentation, even causing suicidal thoughts.

In summary, this section illustrates some of the many ways that the medical record can be helpful in answering questions about a subject. Careful evaluation of the record from a subject’s primary care physician can be extremely helpful in putting the medical condition in perspective. While the temptation to “over-read the record should be avoided and other explanations for the inconsistencies observed should be entertained, it can help determine the subject’s overall medical condition, their threshold for treatment, and associated problems which may predispose them to pain syndromes or change the context of events that occurred during critical periods in the record. Though often the information may seem overwhelming and mundane, giving this document a cursory evaluation can ignore information that may be critical to a case.