GPSOLO October/November 2007
Deciphering Medical Specialties
Attempting to understand medical records and physician specialties can be a daunting task. Crafting your first trial strategy premised on the medical aspects of a case is similar to the initial feelings a skydiver must have when the airplane door opens. As the wind rushes past her, time becomes of the utmost importance. The medical landscape appears as wide as the earth, and she must be proficient with the use of medical materials to land safely. She will be required to educate the medical experts while simultaneously controlling her client’s expectations.
It goes without saying that the type of case will determine the complexity of the medical history and strategy. A small “fender-bender” case will be more complex than a medical malpractice claim. Nevertheless, a comprehensive understanding of the medical specialties involved is crucial to the effective representation of your client.
The term “doctor” is extremely expansive and covers many areas that may or may not deal with medicine. The American Board of Medical Specialties (ABMS) recognizes 25 specialties in fields ranging from allergies to urology. To be certified by the ABMS, the physician generally follows a track after medical school that involves residency training, licensure, general certification, a fellowship program, and subspecialty certification.
In addition, there are many types of physicians that are not ABMS-certified but may be helpful to your case.
Who Are the Usual Suspects?
Family physicians. The most versatile physician is the family physician. This doctor is trained to diagnose a wide variety of ailments in patients of all ages. Moreover, this physician generally places an emphasis on prevention and care of the patient’s immediate family. The family physician is normally trained in a variety of disciplines such as internal medicine, geriatrics, obstetrics, and general surgery.
Practice tip: Patients will likely have a long-standing relationship with these physicians. Therefore, these family doctors may be very sympathetic to the patient and may serve as a patient advocate.
Internists. The practice of internal medicine is the largest primary care specialty in the United States. Where family physicians and general practitioners deal with a broader range of patients, internists are dedicated to treating adults.
The internist may also have subspecialties dealing with certain internal systems or glands. For example, an internist may specialize in diabetes, metabolic and nutritional issues, high blood pressure, musculoskeletal disorders, or gastric or pulmonary systems.
Practice tip: These physicians can be the “glue” that binds the opinions of other experts together. The internist can often assist in coordinating a treatment plan and may assist the attorney in securing well-respected physicians to assist in the case.
Orthopedists. This branch of medicine addresses the prevention or correction of injuries or disorders of the skeletal system and associated muscles, joints, and ligaments. According to its Latin root words (“ortho” and “paes”), orthopedics literally translates to “straightening a child,” as if the child had a broken bone. Hence, these bone and muscle doctors are often the first consults with the internist or family physician.
Also, orthopedists (or “orthopods”) may specialize in the treatment of certain bones or joint systems. For example, some orthopedists will exclusively focus on particular body parts such as shoulders, knees, hands, elbows, or the spine. These physicians are experts on the systemic workings of those body parts and can resolve disputed causation issues or compile future treatment or rehabilitation plans.
Orthopods may also develop their practices into orthopedic surgery. Although this is often in areas of sports medicine, the physicians perform the surgical repairs necessitated by common accidents as well. These surgeons will also be instrumental in developing and monitoring the patient’s coordination of physical therapy and other modalities of recovery. An orthopedic surgeon also addresses the interplay of pathology found in the patient’s central or peripheral nervous systems that affect his or her musculoskeletal components. However, if the patient’s pathology strays too far from the bone or muscle arena, the orthopedic surgeon will likely consult with another specialist.
Practice tip: These physicians specialize greatly and are generally a must in cases where there are broken bones, spine issues, or joint problems. Orthopods are helpful in determining the precise treatment course. These physicians are used by professional sports teams and are often on “staff.” Imagine the joy of informing the trier-of-fact that Dr. So-and-So is the team physician for the NBA champions.
Neurologists. These physicians specialize in the diagnosis and treatment of all types of disease and impairments related to the patient’s nervous system. They are specifically trained on the functioning of the brain, spinal cord, peripheral nerves, muscles, and corresponding blood vessels. These specialists are consulted when there is an impairment in the patient’s ambulatory ability or if there is resulting nerve damage. Some neurologists also subspecialize in a particular aspect such as pediatrics, pain management, or vascular neurology.
In certain circumstances, the services of a neurosurgeon will be required. This highly specialized physician is capable of performing surgery on the nervous system. For example, if a patient suffered a traumatic head injury and his brain is hemorrhaging, a neurosurgeon would perform the corrective procedure. A neurosurgeon may also perform surgery on another part of the body in cases of damage to the peripheral or central nervous systems.
Practice tip: Remember the saying “this ain’t brain surgery”? Well, in these cases, it just may be. Hence, neurologists’ fees for consulting and medical review may be high. However, if you have a closed-head injury matter or nerve damage case, there is generally no way around it. Brace your client and see if you can soften the financial blow.
Who Else May Make an Appearance in Your Case?
Chiropractors. Generally, chiropractors are not doctors of medicine. The doctor of chiropractic (DC) requires two years of college and four years of chiropractic school. However, this does not demean their therapeutic or medical value to the patient. Since 1972 the Medicare Act has included chiropractic services as covered treatment.
Essentially, a chiropractor’s treatment is based on the concept that the nervous system coordinates the body’s functions. Moreover, a basic chiropractic tenant holds that diseases result from a lack of normal nerve function. As a result, manipulation and adjustments of the spine and other body structures may remedy a wide range of ailments. There is a difference in ideologies, however. For example, the International Chiropractors Association believes that patients are to be treated by spinal manipulation alone. In contrast, the American Chiropractic Association believes that a multi-disciplinary approach with other modalities (diet, psychological counseling, and physical therapy) is the best approach.
Practice tip: From a practical standpoint, it is my experience that most insurance companies give chiropractors marginal respect in determining treatment plans and damages.
Osteopaths. The science of osteopathic medicine has been around since the 19th century. The practice focuses on the concept that the human body is capable of composing its own remedies against diseases when it maintains a normal “structural relationship.” This holistic approach embraces modern medical knowledge including pharmacology and surgery. Osteopathic medicine includes spinal adjustments and other manipulation of the skeletal structures.
The academic course undertaken by most osteopaths is equivalent to that of a traditional MD (doctor of medicine), and these doctors are licensed to practice medicine, prescribe medication, and perform surgery.
Practice tip: In my experience, these physicians are easy to work with and are down to earth. The osteopath is well suited for understanding the companion systems involved in treating the patient. They are generally very sharp and understand the end result the patient is trying to achieve.
Physiatrists. In non-surgical cases, a physiatrist is consulted as she specializes in physical and rehabilitation medicine. These physicians aim to restore optimal function to patients with bone, tissue, and muscle injuries. A physiatrist is specially trained in electromyography and nerve conduction studies to evaluate neurological disorders.
Practice tip: These physicians work closely with the physical therapist to restore a level of health and movement back to the injured patient. Some physiatrists are trained in providing impairment ratings and are well versed in securing a rehabilitation plan that incorporates the various disciplines.
Psychologists and psychiatrists. The primary difference between these two mental health professionals is the fact that psychiatrists are doctors of medicine(MDs) and psychologist are doctors of philosophy (PhDs). Both professionals deal with the prevention, assessment, diagnosis, treatment, and rehabilitation of mental illnesses. However, the psychiatrist is able to treat patients with pharmacology and medication. Generally, a psychologist specializes in applied behavior, cognition, perception, and interpersonal relationships.
Practice tip: The choice to consult one professional over the other, especially when a mental injury is alleged, should be made on a case-by-case basis. For example, a child psychiatrist may be consulted in a serious injury matter where the use of prescription drugs and extensive therapy will be a part of the victim’s life. On the other hand, a child psychologist may be consulted in a divorce or family case.
Working with Medical Professionals
The most obvious statement one can make about working with physicians and medical personnel is, “doctors are expensive.” Below are additional practice tips:
• Research the doctor’s credentials. Most states have online access to the board’s record, where it will list disciplinary actions and significant malpractice settlements. Your adversary will have these facts as well, so choose wisely.
• Research the doctor’s reputation. Not all doctors are created equal. If you have access to a listserve or trusted network system, pose the question about your prospective expert. These resources are very candid and may have prior deposition transcripts for you to read.
• If you represent a personal injury victim, educate him or her about the physician’s role in the process. If your client will be treated or evaluated by the physician, your client should be made aware of the doctor’s credentials and consent to treatment.
• Like you, doctors are very busy professionals. When you call, be clear about what you are requesting, and be brief.
• Be ready to issue a prepayment.
• Some physicians may require you to submit the records to them prior to their agreeing to serve as experts. Have a copy of the records ready for review.
• After the physician agrees to assist you, solidify the agreement in writing with specific terms of the arrangement.
• Before the physician creates a report, request that you meet to discuss the contents. You may not want the report.
Retaining a physician may pose a significant financial burden to your client, as many physicians will charge several hundred dollars per hour to consult with you regarding your case. However, their opinions will likely drive your personal injury case and may ultimately determine the verdict.
Bryan C. Ramos practices law in Atlanta, Georgia, and may be reached at firstname.lastname@example.org.