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MEDICOLEGAL NOTHING TO DISCLOSE Slide 2 BAGNALLS MAXIM POWERPOINT IS THE VIAGRA OF PUBLIC SPEAKING DISCLOSURE: I HAVE NO INTEREST, WHATSOEVER, IN VIAGRA.EVER!! Slide 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.IMES/DEPS FOLLOWED PI: LOCAL DOCTOR RUN REFERRAL SERVICE WCI: TREATED PATIENTS, IMES FOLLOWED Slide 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 Slide 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 Slide 6 THE WCI ARENA WHAT IS WCI? LAWS DIFFERENT (PAIN/SUFFERING) ARBITRATOR/EV DEP TREATED THESE PATIENTS MET THE NCMS ADJUSTORS HEARD OF/LIKED ME (?) TREATED THE NCMS, ADJUSTORS &/OR FAMILY Slide 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 Slide 8 MEDICAL MALPRACTICE ARENA MESSY CANT AFFORD ME PLAINTIFF OPINION WORK UNTIL Slide 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 REPORTADDEND TELL THE TRUTH, BE HONEST IVE LOST BUSINESS FINDING MISSED PATHOLOGY Slide 10 IME STANDARDS SCHOFFERMAN J. PAIN MED. 2007 MAY- JUN;8(4):376-82 MARTELL MF, ET AL. PHYS MED REHABIL CLIN N AM. 2001 AUG;12(3):571-85 RICH BA. PAIN MED. 2006 SEP-OCT;7(5):460-3 BAL S. CLIN ORTHOP RELAT RES. FEB 2009;467(2): 383-391 KLEE CH. NEUROREHABILITATION. 2001;16(2):79-85 Slide 11 IME STANDARDS (CONT.) REPORT TO AMA BOARD OF TRUSTEES, B OF T REPORT 5-A-98 AMA GUIDES NEWSLETTER NOVEMBER/DECEMBER 2005 EDITION http://www.ama-assn.org/ama/pub/physician- resources/medical-ethics/code-medical- ethics/opinion907.page http://www.ama-assn.org/ama/pub/physician- resources/medical-ethics/code-medical- ethics/opinion907.page http://www.cbs.state.or.us/wcd/communication s/publications/4913.pdf http://www.cbs.state.or.us/wcd/communication s/publications/4913.pdf Slide 12 MARKETING Slide 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! Slide 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 Slide 15 MARKETING TO PI I DONT.PERIOD LISTS (PAID VS FREE) LISTING/REFERRAL COMPANIES ADS ABIME, AADEP CERTIFICATIONS (INCLUDING ACRONYMS AFTER YOUR NAME) IICLE TALKS Slide 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. Slide 17 PAIN DIAGRAM Slide 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. Slide 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 Slide 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? Slide 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 Slide 22 BUSINESS OF DOING BUSINESS NO SHOW/LATE CANCELATION OF IME=FULL CHARGE I BILL IMES PER BODY PART, PER INJURY, EXTRA FOR COPIOUS RECORDS TRAVEL TIME MAY BE BILLED (PORTAL TO PORTAL) Slide 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 FRONTALWAYS Slide 24 DID I MENTION? ALWAYS ALWAYS Slide 25 DID I HAVE AN OPINION? Slide 26 IS SURGEON IN A BETTER POSITION?DISCREDITED? Slide 27 AM I A PSYCHOLOGIST? DISQUALIFICATION ? Slide 28 IS HE A MALINGERER? OVEREXTENSION? Slide 29 DONT DO MEDICOLEGAL IF: CANT ARTICULATE WELL DURING TESTIMONY CANT BACK UP ARGUMENTS WELL WITH RELEVANT EVIDENCE BASED STUDIES DONT FEEL COMFORTABLE WITH TAKING ON DOCTORS WITH DIFFERING OPINIONS CANT TAKE THE HEAT OF UNHAPPY PATIENTS (RATINGS) CANT BE DECISIVE WITH DIFFICULT OPINIONS/RECOMMENDATIONS Slide 30 DONT DO MEDICOLEGAL IF (CONT.): CANT BE PROMPT WITH (LONG) REPORTS ARE BAD/INFLEXIBLE WITH DEADLINES CANT BE AVAILABLE FOR SCHEDULING OF IMES, DEPOSITIONS CANT GET TO RECORD REVIEWS PROMPTLY ARE NONCONFRONTATIONAL DONT LIKE TALKING TO LAWYERS Slide 31 DESTINATION: TENACATITA