Objective Assessment Solutions, Inc.

2011 Medical Legal Skills Workshop;

Fact Based Opinions and Testimony
Removing Bias from Personal Injury Medical Legal Assessment
Marriott Newport Beach Resort and Spa • Newport Beach, CA • March 26-27, 2011

Why do medical legal experts generally know more about patients they evaluate and often have
more studied and learned opinions about diagnostic test results and treatment than treating
physicians? Why do the decisions and treatment plans of treating physicians lead to
unsatisfactory outcomes in many patients they take care of? What are the medical legal skills
that can help improve this situation?

Traditional medical education focuses on anatomy, physiology, biochemistry, pharmacology and

how illness, injury and disease affect body systems and function. It does not pay particular
attention to cultural, social, economic, psychological or emotional factors that impact health,
well-being and productivity. Standard undergraduate and post-graduate or fellowship medical
education and training techniques do not foster the doctor-patient relationship. The academic
environment does not effectively prepare doctors to truly get to know their patients as
multifaceted human beings. In this era of managed care and reduction of reimbursement,
doctors feel they must work twice as hard to make half as much income. Time spent between
doctor and patient is further compromised as a result.

In this setting, it is important that doctors concentrate their attention on obtaining the most
valuable information from their patients that they can. Treating physicians, however, are inclined
to get the information from patients that is quick and easy to obtain rather than what might take
more time and effort, but be more useful. Patients’ verbal histories are usually accepted at face
value and frequently nothing is done to verify the accuracy of the information. The focus tends
to center more on the patient's symptoms or subjective complaints than on physical or objective
diagnostic findings of abnormality.

As a result, diagnoses are often far more descriptive of symptoms than pathology. If the
motivation and multifaceted aspects of patient complaints are not factored into the equation, the
diagnosis may be erroneous and the treatment prescribed unsuccessful.

Doctors are frequently confused and disheartened when their diagnoses are incorrect or their
treatment plans do not produce satisfactory outcomes. Patients are unhappy when they do not
get well and return to productivity or the problems they are having are not well-understood,
explained or taken care of. This leads to breakdown of the doctor-patient relationship.

Everyone loses.

Obviously, there must be a better way. It is not enough to determine what is wrong and what to
do about it from limited information. A more complete and holistic approach is required.

www.medicalexpertcme.com
 Objective Assessment Solutions, Inc.
2011 Medical Legal Skills Workshop;
Fact Based Opinions and Testimony
Removing Bias from Personal Injury Medical Legal Assessment
Marriott Newport Beach Resort and Spa • Newport Beach, CA • March 26-27, 2011

Obviously, there must be a better way. It is not enough to determine what is wrong and what to
do about it from limited information. A more complete and holistic approach is required.

In contrast to the techniques of the treating physician, skill sets of the medical legal professional
take a different approach. Here, instead of the doctor accepting the patient's subjective
complaints true as expressed, the examiner asks pertinent questions, takes historical
information into account, and verifies it with prior medical records, diagnostic tests and other
practitioners' examinations, diagnoses and treatment plans. In addition, there is a careful
scrutiny put on alleged mechanics of injury, epidemiology or exposure to determine if they
support the complaints and test findings.

Experienced medical legal professionals are also trained to perform a causation analysis.
Causation is defined as "the act or agency by which an effect is produced"; hence the phrase
"cause and effect". This analysis adds the all-important third leg to the platform only partially
supported by the first two legs of clinical diagnosis and treatment. It is clear that three legs
create a more stable platform to analyze medical or surgical problems than a platform with two.
Taking into account symptoms, objective findings of physical abnormality and diagnostic test
results, and considering causation gives the best chance of a useful understanding of the
"whole" person and the real situation they find themselves in. This will lead to better diagnoses
and more successful treatment plans.

Medical legal skills are required when doctors must assist their patients in the areas of workers
compensation, short- and long-term disability, impairment, personal injury and medical
malpractice litigation. Physicians have an ethical duty to assist their patients in these aspects of
their health care and wellness. Unfortunately, doctors are poorly trained by standard
educational institutions to do this. As a result, doctors will often refuse to be involved in these
cases, or will function poorly when they are unable to avoid the matter. This is a disservice to
patients and becomes a shortcoming of many physicians and surgeons who do not understand
the challenges their patients face in these "real world" situations. The patients are commonly left
to fend for themselves, which is not in their best interest, nor in that of the physician -- who may
still have to get involved when the problems become more complicated and time-consuming.
The multifactorial aspects of illness, impairment and disability are taken into account in the
medical legal setting.

Health care providers with an understanding of multi-factorial interrelationships are better able
to diagnose, treat and assist their patients. A great deal of what physicians are asked to
evaluate is patient complaints of pain. Knowledge about how to correctly assess pain and
determine how it affects the life and responsibilities of patients in settings outside the examining
room is critical in selecting the best ways to treat pain and relieve it. When pain is in excess of
objective explanations to explain it, the medical legal expert is trained to look for non-organic or
secondary gain explanations that, when they remain unrecognized, cause pain and disability to
continue or increase.

www.medicalexpertcme.com
 Objective Assessment Solutions, Inc.
2011 Medical Legal Skills Workshop;
Fact Based Opinions and Testimony
Removing Bias from Personal Injury Medical Legal Assessment
Marriott Newport Beach Resort and Spa • Newport Beach, CA • March 26-27, 2011

Another key concept in medical legal work is that of "probability or reasonable medical
certainty", defined legally as "from 51% or more likely (than not)". This measurement helps to
determine what diagnoses are probable ("more likely that not") and which are only possible.
When combined with a causation analysis the doctor is able to reach additional conclusions,
such as whether an accident of exposure had the probability to create injury, and whether the
physical examination demonstrates findings of an injury that would probably be associated with
such an accident. When both are probable then there is reasonable medical certainty --
"probability" -- that the two are related.

The skill sets of the medical legal professional and the education that leads to becoming a
medical legal expert, when used in the clinical setting contribute strongly to improving treating
doctors' evaluation, diagnosis and outcomes of treatment. More importantly, in the medical legal
setting doctors learn to develop a clear, logical, scientific opinion based on fact, and to
convincingly explain or advocate to laypeople or the courts, often under duress. This leads to
the development of skills and techniques that create solid opinions and the confidence to defend
them. Lastly, the skills learned in the medical legal arena help doctors see their patients as real
people with complicated problems that are not completely physical in nature. The doctor can
then take a more holistic approach to their patients' health care and return them to wellness and
productivity faster and more effectively.

The 2011 Medical Skills Workshop will provide physicians with an overview of medical legal
skills needed to perform an objective evaluation. One whole day will be devoted to a moot court
in which attendees will have the opportunity to serve as experts and jury members.

The meeting will be held Marriott Newport Beach Resort and Spa in Newport Beach, CA, March
26-27, 2011. Presented by Objective Assessment Solutions. Sponsored by Benchmark, CME,
Inc. Registration is open now.

John L. Chase, MD, FACS is a board certified orthopedic surgeon, graduate of the UCSF
Orthopedic Residency with Fellowship training in Joint Replacement Arthroplasty and over 30
years of experience in the medical legal field. Dr Chase is the Founder of Benchmark Medical
Consultants, Inc. which was acquired by ExamWorks, Inc. in August of 2009. Dr. Chase
specialized in Sports Injury diagnosis and treatment and was the Orthopedic Consultant to the
Athletic Department at UC Davis, Honorary Medical Officer to USA Rugby, and Team Physician
for the USA Eagles National Rugby Team 1975-1997. His current practice is as an Orthopedic
Consultant with the US Department of Veterans Affairs, Sacramento VA medical Center and
Member of the Clinical Faculty, Department of Orthopedic Surgery, Division of Arthroplasty,
UCSF.

www.medicalexpertcme.com