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. 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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