Understanding Medical-Legal Evaluations - Part 2

Monday, December 9, 2002 | 0

Our first article in this series on medical-legal examinations and reports reviewed what the purpose is and how the medical-legal report affects your case. Remember though, a medical-legal report starts with the examination, and what that report says is directly affected by what happens in your medical-legal appointment.

The role of the medical-legal doctor (or in some cases chiropractor) is different from your treating doctor and, for that reason, the medical-legal examination may seem less personal than you have come to expect from regular medical examinations. Doctors you consult on your own behalf are free to tell you their thoughts about your case and offer advice, but in the case of medical-legal evaluations the examining specialist will be loath to, for ethical and legal reasons, discussing such things with you. If the examining specialist believed a particular treatment might be very helpful to you, his or her remedy may be to suggest it to your treating doctor, though he or she may not necessarily be obligated to do so.

However, some things should be similar to your usual experience of medical examinations. First off, a physician licensed to practice medicine is still a physician, meaning that they are bound by legal and ethical duties to provide the same standard of care as a traditional medical consultation.

The practitioner should make his / her role clear prior to the start of the consultation, should observe the normal courtesies and respect for a patient's privacy and inform the patient of the nature of the examination. This is particularly so if the practitioner detects apprehension or if a test may produce pain. It is rarely necessary to persist with an examination beyond the first indication of pain. Whether or not the response appears reasonable, the practitioner should not proceed in the face of objections by the patient or patient's representative without further explanation and clear agreement about going forward.

On that understanding of the relationship you have with the examiner, you should clearly indicate if any part of the examination is likely to or actually causes pain, especially if it is severe. In such circumstances, the examiner requires your consent to continue with the particular activity concerned.

As we have mentioned in prior articles on this site, honesty is paramount, especially in a medical-legal evaluation. The professional conducting the examination typically has some training in forensics and can detect false indications of pain. Further, the physician will typically be apprised of your prior medical history, some of which you may be aware of, and other facts that may not be known to you.

Since the medical report is "evidence", if it is based on false history then any conclusions the physician reaches would then be subject to attack and discrediting. If the physician is writing a report on your behalf, then his report may be thrown out. If the physician is writing a report for the insurance company, then you may be required to visit the doctor again, or you may be penalized, or the judge may cast all of your testimony in a disparaging light.

On occasion, a practitioner may delve into personal information that may be questionably relevant. It is reasonable, in such a situation, to request the examiner explain the relevance of a question that you feel may be too personal or would constitute an unreasonable breach of your privacy. But again, evasiveness or uncooperativeness may lead to undesirable results.

In all cases, if you believe that the physician is acting inappropriately, then you should stop the examination immediately and seek the counsel of your attorney before proceeding further. If you are not represented by counsel, and are reluctant to engage the services of an attorney, then you should request a rescheduling of the examination to permit you time to discuss the matter with your state workers' compensation assistance officer, the claims examiner handling your case, or in extreme cases you may wish to request a hearing before a workers' compensation judge.

Remember that your case is necessarily dependent on medical evidence, and that evidence is presented almost all of the time through a report. Your conduct in the examining room will be translated to the report, and will impact your case.