Winning Medical-Legal Reports

by Lew Brenneman, MD, PhD

The most common reason that attorneys "don't do their job" is because they cannot find an expert witness to render a decisive opinion on your case. Most doctors are reticent to make definitive statements in the legal arena -- even when their own history and examination demonstrates a disorder. Without a compelling expert medical opinion backed up by pertinent medical literature, the attorney is left without a foundation upon which to build a case, and the opposition attorneys are quick to take advantage of any weakness. Without a definitive expert witness, the attorney has no case.

During my reviews of numerous patient records, I often see physicians contradict themselves by stating a much weaker conclusion than their findings warrant. Physicians often make strong statements to their patients but much weaker ones to an attorney.

Some examples of weak versus strong statements are:

Weak Strong
1a. It appears that the patient experienced symptoms of ... 1b. There is substantial evidence that this patient is afflicted by ...
2a. Based on my diagnosis and treatment, the symptoms are consistent with the kind of chemical exposure to which the patient was subjected ... 2b. Based on the documented history, examination, diagnosis, and pertinent medical literature, the preponderance of evidence demonstrates that the chemical exposure to which the patient was subjected is clearly the cause of his/her disease and subsequent inability to perform gainful employment ...
3a. The symptoms of the patient may be associated with the chemical exposure in 1993 ... 3b. The disorder of the patient was caused by the chemical exposure of 1/2/93 ...
The aversion of physicians to state the facts of a case is devastating to the patient when their opinions are devoid of the vital issue of causation. Physicians are prone to prattle about their diagnoses and treatment while omitting documented medical history, work incapacitation, reduced quality of life, and loss of career opportunities and income, as if these issues were irrelevant. For example, if shoulder pain prevents adequate grooming, this must be forcefully stated without dilution by superfluous issues, since grooming impacts upon career opportunities and therefore income. This problem is compounded by the absence of a clear and concise summary of the evidence for causation. Listing separately each piece of evidence for causation is vital in order to avoid confusion and dilution of the facts.

Why are many physicians so intimidated by legal cases? Simply because they have not taken the trouble to investigate the laws concerning medical experts. The expert has the responsibility to state an opinion as long as it is their true belief. In addition, their opinion is strengthened by providing medical literature support, but obtaining such literature support often requires extensive searches, which are time consuming and costly. Whereas the opposition can easily afford professional search teams, the plaintiff often cannot. Thus a report with safely muted language renders the value of the medical expert virtually useless.

After all, the attorney's job is to present a compelling case and emphasize the opinions of the medical experts, but they cannot render medical opinions. Only medical experts can render such opinions. So herein lies the problem: a weak medical opinion is subject to destruction by the opposition, while a clear and definitive one can withstand such destruction.

What can a patient do to get a fair evaluation from physicians?

1. Ask the physician what he thinks is the cause of the problem.

2. Ask the physician for a rough draft of the report before it is finalized.

If the physician is unwilling to comply with these requests, then find another one if possible.

# # #

I appreciate your feedback and criticism.

Contact me at:
Tel 415-677-0829 | Fax 415-677-9745 | E-mail brenn@sfo.com

Lew Brenneman, MD, PhD © 1998




Other articles by Dr. Brenneman, also published inEHN's newsletter, The New Reactor --



Q&A Sessions

Meet with Dr. Brenneman and friends in his office, the second
Wednesday of the month. Please verify with a call or by e-mail.


The URL for this web page of Immunology Medical Associates is:
http://users.lanminds.com/~wilworks/immune/winmedle.htm

Return to Immunology Medical Associates

winmedle.htm 8/27/98


Dr. Lew Brenneman's paper on Winning Medical-Legal Reports -- Physicians are prone to prattle about their diagnoses and treatment while omitting documented medical history, work incapacitation, reduced quality of life, and loss of career opportunities and income, as if these issues were irrelevant.The URL for this web page of Immunology Medical Associates is:
http://users.lanminds.com/~wilworks/immune/winmedle.htm