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 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.
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.