Medical-Legal Support Within Reasonable Medical Probability A s professionals, our job is to be fair and objective. In health care, we ensure that our patients receive the best possible care for their ailments. When then there is a potentially compensable claim, however, our roles often extend into the world of legal probability. For those of us who see a wide variety of patients including injured workers or those with personal injury claims, we may have to wear a variety of different “hats” throughout the day. As an orthopedic surgeon, the way I approach a 70-year-old who has a rotator cuff tear but doesn’t recall an injury is going to be different from the way I approach a 30-year-old who was in a car accident and now has a meniscal tear. The 70-year-old is only worried about how I’m going to take the pain away, whereas the 30-year-old will have questions regarding the injury and specific requests related to the personal injury claim. When evaluating a patient with a potentially compensable claim, it is important to gather a good history with specific information regarding the injury. Either as the treating doctor or during an Independent Medical Examination (IME), one has to sift through the history and try to decipher subjective from objective. For me, the objective information provides the framework by which I can fill in the gaps with the subjective narrative to recreate the injury. A detailed description of the position of the joint at the time of injury, the force exerted on the body at the time of impact, when the symptoms started, and when the injury was reported are all critical when building that framework. Subjective information such as if the patient felt or heard a “pop,” the location and nature of the symptoms, and their response to prior treatment helps fill in the gaps. Asking specific questions can often reveal a history of previous injury or symptoms—important By Amon T. Ferry, MD information when it comes time to determine causality. Understanding a previous injury, reviewing prior imaging and assessing for pre-existing symptoms all play a role when attempting to understand the cause of the current complaints and if the symptoms are related to a new injury. An amazing amount of objective information can be gained by observing the patient throughout the visit and performing a good physical exam. Occasionally, I will see a patient that will reach freely onto the floor to pick up a heavy bag early in the visit, but then during a focused exam of the shoulder they are unwilling to move the arm and provide sub-maximal effort to strength testing. In other situations, the findings on imaging studies do not correlate with the symptoms or physical exam. In these situations, we must ask ourselves if we feel that the physical exam is valid or if there are inconsistencies that should render the physical exam unreliable. Personal review of the imaging is important and helps us confirm our diagnosis and assess the severity Dr. Ferry, originally from Illinois, relocated to Phoenix with his wife and two daughters. He and may provide clues to the chronicity. We may be able to assess for subtle findings on an X-ray or MRI that may be outside of the requirements of the radiologist. Muscle atrophy, degenerative tissue has extensive training in arthroscopic surgery or reactive bony changes may help give us clues that the symptoms may be related to a more chronic of the knee and shoulder and has experience condition. For the patients that I see in the office that do not have advanced imaging, I am quick to caring for injured athletes from high school recommend further testing because it is much easier to define the exact cause of the symptoms early in to the professional level. He is a board certified, fellowship-trained orthopedic surgeon. the post-injury period and facilitates a more accurate prognosis and treatment plan to be created. In Boston, he worked with the New England As medical professionals, we have the opportunity to not only treat patients with an industrial injury Patriots, the Boston Red Sox and the Boston or personal injury claim but also evaluate these patients in an IME. For those of us with busy active Bruins caring for their players. Active in re- practices that perform IMEs, this provides the experience to better understand our role in the legal search, he has published on a variety topics in both orthopedic journals and textbooks. process and can help us provide the valuable information that is needed to ensure that a fair and objective Dr. Ferry accepts most insurance plans, sees assessment is provided. In my experience, a thorough IME or record review performed by an expert that injured workers, patients with personal in- is deemed fair by a judge may help ensure that the patient’s rights are protected. By understanding and jury claims, and performs IMEs. For more information, please contact David Klecka via appreciating the unique challenges posed by an individual with a potentially compensable claim this email at firstname.lastname@example.org or at allows medical professionals to ask the right questions, form opinions regarding causality, and ultimately (602) 282-3346. provide an opinion that is within reasonable medical probability and based on our expert opinion.