The MVA Patient -

1. The MVA Patient - Your Favourite!

2. Why Family Doctors?

3. Why Family Doctors? • experts in Family Medicine

4. Why Family Doctors? • experts in Family Medicine • know the patient best

5. Why Family Doctors? • experts in Family Medicine • know the patient best • jurors have family doctors and tend to relate to them well

6. Why Family Doctors? • experts in Family Medicine • know the patient best • jurors have family doctors and tend to relate to them well • experience with chronic conditions

7. In What Typesof Cases?

8. In What Types of Cases? • “chronic pain” personal injury cases

9. In What Types of Cases? • “chronic pain” personal injury cases • “before and after”

10. In What Types of Cases? • “chronic pain” personal injury cases • “before and after” • clarify impact of pre-existing impairments

11. In What Types of Cases? • “chronic pain” personal injury cases • “before and after” • clarify impact of pre-existing impairments • explain clinical course

12. CAUSATION

13. CAUSATION • did the MVA cause the pt’s symptoms?

14. CAUSATION • did the MVA cause the pt’s symptoms? • consideration of pt’s prior hx

15. CAUSATION • did the MVA cause the pt’s symptoms? • consideration of pt’s prior hx • line between pre-accident and post-accident hx is blurry

16. CAUSATION • did the MVA cause the pt’s symptoms? • consideration of pt’s prior hx • line between pre-accident and post-accident hx is blurry • accident need not be the sole or direct cause of symptoms

17. CAUSATION • “material contribution” Supreme Court of Canada says: ‘Where the “but for” test is unworkable, the courts have recognized that causation is established where the defendant’s negligence “materially contributed” to the occurrence of the injury.’

18. CAUSATION • positive scientific proof not required

19. CAUSATION • positive scientific proof not required • recognizes multifactorial nature of many conditions

20. “INJURY vs. IMPAIRMENT”

21. “INJURY vs. IMPAIRMENT” • emphasis on impairment, not injury

22. “INJURY vs. IMPAIRMENT” • emphasis on impairment, not injury • no functional impairment = no case

23. “INJURY vs. IMPAIRMENT” • emphasis on impairment, not injury • no functional impairment = no case • injuries heal but impairments remain, e.g. chronic pain

24. “INJURY vs. IMPAIRMENT” • emphasis on impairment, not injury • no functional impairment = no case • injuries heal but impairments remain, e.g. chronic pain • do impairments interfere with daily life tasks?

25. ANATOMY OF A MEDICAL-LEGAL REPORT

26. Nature of document

27. Mrs […] is a patient of this medical clinic under my care. I have been asked to provide some further information as to her level of functioning before and after the accident that she sustained on September 3 1998. • Nature of document • medical-legal report • requested by legal representative

28. Summary of qualifications

29. I am a qualified medical practitioner, licensed to practice in the Province of Ontario. I graduated from the University of Western Ontario Faculty of Medicine in 1993 and received my certification as a Family Practitioner from the Canadian College of Family Physicians in 1995. • Summary of qualifications

30. 3. Brief summary of pt’s hx in your care

31. Mrs. […] has been a patient of mine since July 31 1996. • first contact

32. When I met her she was quite a functional lady with a history of Paget's disease that was under reasonable control and a previous history of several abdominal surgeries. In general though, visits to the office were over minor concerns such as upper respiratory tract infections. • pt’s past hx

33. 4.Details of event as related by pt

34. On September 4 1998 Mrs […] was seen in the office the day after an accident that happened to her in a store when a rack of picture frames fell on her injuring her right shoulder. • first meeting post-event

35. own examination and findings At that time an examination was carried out and x-rays were obtained which did not show a clinical fracture.

36. list complaints and… In short any activity that involves the use of her hands and arms causes pain in the shoulder girdle area. This presents a problem for simple activities of daily living[…]

37. This presents a problem for simple activities of daily living such as dressing and feeding and certainly has been a limitation with respect to her interaction with grandchildren. She has required a number of modifications to her home such as ergonomic aids in the kitchen and bathroom. • …functional limitations

38. […] there has been a rather large psychological impact as well […] • including psycho-emotional sequelae

39. 5. Summarize history post-event

40. 5. Summarize history post-event Mrs […]'s visits to the office as of late have been for routine issues including another respiratory tract infection as well as more recently some dizziness for which a neurologist was consulted but to my knowledge no serious diagnosis was entertained and an MRI of the head was reported as normal.

41. 6. Opinion

42. 6. Opinion Certainly it is clear to me that Mrs […]'s level of functioning has been quite profoundly affected by this accident and its resultant chronic pain.

43. 7. Current status and management

44. 7. Current status and management • dx

45. 7. Current status and management • dx • further tests & tx

46. 7. Current status and management • dx • further tests & tx • anticipated benefit of further tx

47. 7. Current status and management • dx • further tests & tx • anticipated benefit of further tx • prognosis

48. 8. Answer critical questions

49. 8. Answer critical questions • current level of function?

50. 8. Answer critical questions • current level of function? • level of function pre-event?