Our Services: Medical records
Summarizing medical records
The
pressure is on you to settle cases as effectively and quickly
as possible. When you are juggling multiple files, the effort
involved in keeping track of your client's injuries and
medical records can turn the easiest case into a complex
one. Everything from coding to medical
transcription needs to be correctly performed. Medical
summaries provide an essential tool for the resolution of
personal injury cases. A medical summary is prepared by
a legal nurse consultant for use by the attorney in settling
cases. The summary concisely describes the accident, the
mechanism of injury and the immediate care provided at the
scene and in the emergency room. The records of hospital
stay and of subsequent treating physicians are summarized,
along with the results of diagnostic testing. The treating
physicians' comments regarding causation of the injuries,
prognosis and permanency are included in a medical summary.
The medical expenses can be listed as well. A separate letter
to the attorney points out the missing records, red flags,
and problematic medical issues.
It is
no longer sufficient to present information to the trier
of fact without adding illustrations. The increasing sophistication
of jurors, mediators and judges mandates incorporation of
demonstrative evidence into arbitrations, settlement brochures,
meetings and trials. Complex concepts are best explained
by a combination of text and graphic depictions. Vivid demonstrative
aids are useful for maintaining the interest of the trier
of facts who have become accustomed to the graphics added
to articles or television shows such as the news.
This
article will provide an overview of the use of enhanced
medical summaries. Traditional medical summaries consist
of a text-based summary of the plaintiff’s medical
records. They are often incorporated by the plaintiff attorney
into a statement of the facts of a claim, a settlement brochure
or a demand letter. The emphasis is on the plaintiff’s
symptoms, treatment, prognosis and permanency of injuries.
The plaintiff attorney handling a personal injury claim
uses the summary to understand the injuries, present a claim
of damages and prepare for arbitration or trial. The defense
attorney uses the summary in much the same way, but with
an important difference. The medical summary prepared by
the defense may highlight pre-existing injuries or illnesses
unrelated to the claim, subsequent injuries from other accidents,
discrepancies in the plaintiff’s story or otherwise
expose weaknesses in the claim.
Charts
and tables
Medical
summaries are enhanced with tables and charts, which are
among the most cost-effective exhibits. These illustrations
should conform to principles of desk top publishing. Observing
the rules of layout includes using a consistent font and
adding color for emphasis to an otherwise black and white
exhibit. Selection of colors for exhibits can have a profound
impact on readability and persuasiveness of an exhibit.
Black letters on a yellow background are frequently used
combinations for headings or for important information on
a chart. Charts should also be planned with adequate white
space to avoid crowding of content.
When
there is a dramatic difference in lifestyle before and after
an injury, a chart can effectively show the changes. Symbols
and colors are commonly assigned to each type of activity.
One type of chart shows all of the activities the individual
engaged in before the injury, in contrast with the greatly
diminished or absent ability to engage in these same activities.
When the defense disputes that a dramatic difference in
lifestyle has occurred, a chart can be created which shows
that the plaintiff is able to participate in the same activities
both before and after the injury. In another format, the
normal growth and development of a child can be contrasted
with the arrested or delayed growth and development following
an injury. Looking at this issue from the opposite perspective,
the activities of a relatively healthy individual can be
contrasted with an after the injury chart showing multiple
hospitalizations, surgeries, trips to the doctors and physical
therapy. These can be presented in a typical 12 month calendar
with one exhibit devoted to the before and one to the after
the injury time frame.
Charts
which are set up in columns can compare information such
as the essential steps in the fulfillment of the standard
of care with the actions taken by the defendant. Software
can be used to create graphs of medical visits, demonstrate
a pattern of full time employment versus time spent out
of work and so on.
Tables
prepared by a consultant who has analyzed medical records
may present various aspects of pain and suffering. These
exhibits may summarize problems the plaintiff experienced
over a course of time, show total doses of pain medications
or list or show all of the invasive medical equipment which
was used on the patient. When a patient is subject to particularly
painful sensations, a chart can be designed to indicate
the patient’s level of consciousness or detail the
patient’s expressions of pain or anxiety, as shown
in the medical records. A frontal image of a body can be
supplemented with text boxes which list all of the injuries
associated with a trauma.
Pie
charts, bar graphs and line charts, if kept simple, can
convey important information in a visually appealing way.
Tables prepared by the defense experts and consultants may
point out inconsistencies in the plaintiff’s versions
of events, demonstrate that the patient withheld information
from treating physicians, or was noncompliant with medical
treatment.
Timelines
Timelines
are invaluable whenever the trier of fact will be expected
to understand a sequence of events. A number of formats
can be created. A common method of displaying this type
of information is to use a horizontal line with boxes containing
key data placed above and below the line. An equally effective
use of a horizontal timeline is based on life expectancy.
Consider the impact of a timeline in a case based on an
alleged delay in diagnosis of breast cancer in a 40 year
old woman. The date of the patient’s death would be
marked on the timeline, followed by a line that is based
on the patient’s life expectancy had she been diagnosed
at an earlier stage.
A variation
of the horizontal timeline is to create parallel horizontal
lines. This approach was effectively used in a settled case
involving a failure to diagnose a cervical fracture. The
three horizontal lines consisted of the events, the condition
of the patient and evidence that spinal precautions were
or were not being used. The preparation of this timeline
by Med League Support Services, Inc. convinced the defense
counsel that the plaintiff attorney had an excellent grasp
of the facts of the case and was thoroughly prepared to
try the case.
If the
goal of the timeline is to focus on the events which occurred
over minutes or hours, clocks with the applicable time can
be included in the timeline. The event which occurred at
each time frame can be placed next to or under each clock.
Principles
guiding the preparation of timelines include keeping the
time segments uniform and in scale. For example, do not
have one segment of the timeline represent 15 minute increments
and have an equal size segment represent 2 weeks. The use
of colors should not distract from the information. Avoid
the tendency to crowd too much information onto one page.
Medical
illustrations
The
sources of medical illustrations include hand drawings,
textbooks or other printed material and software. Scanned
photographs of the plaintiff personalize the medical summary
and are useful for showing scars, medical equipment, and
other aspects of damages. When graphic photographs of the
client’s injuries are inadmissible, a medical illustration
can convey the same information without the intense shock
the actual photograph would engender. An effective way to
make the illustration more personalized is to superimpose
the anatomical images over the patient’s actual face
or body. If mounted enlargements are used, overlays can
be used to illustrate such concepts as the injury, the steps
in the surgical repair and the final result.
There
are a number of software products on the market which incorporate
medical illustrations. These images may be cropped, resized
and dropped into medical summaries, settlement packages
or enlarged into exhibits. They may be placed side by side
with the x-ray or drawing which illustrates the client’s
injuries. Labels for anatomical parts should be in bold.
The exhibits should include orientation drawings so that
the viewer can identify the location of the clasp. Presentation
of the normal anatomy next to an image of the injury permits
the trier of fact to make the needed comparison. To avoid
confusion, the normal image should be in the same anatomical
position as the image of the client’s injury. The
images should be kept simple. A disadvantage of using a
textbook illustration is that there is often too much unnecessary
and distracting detail.
The
inclusion of charts, graphs, timelines, and medical illustrations
enliven medical summaries. They add necessary details to
explain complex concepts and series of events.
Med
League Support Services Inc. offers enhanced medical summaries:
contact us!
See also:
Organizing
medical records
Analyzing medical records
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