Medical Legal Report Writing -Medical Causation vs Legal Causation
Dr. Gurdeep Parhar
Clinical Professor, Co-Founder Adult ADHD Centre, Speaker/Researcher, Occupational Physician, Disability Medicine
As health care professionals, it is usually critically important that we have sufficient evidence to be VERY confident about our impression/diagnosis.
That is, in order for us to be "convinced" about a particular diagnosis we need to make sure we have ruled out other diagnoses or have decided that they are "less likely" than our working diagnosis.
Similarly, in order for health professionals to recommend a particular treatment we need to have a high level of confidence that the treatment is truly going to be safe/effective.
Thus, when health care practitioners are asked to offer an opinion on causation we often approach it with that same expectation of needing a high level of evidence. What needs to be kept in mind is that in civil proceedings, as opposed to criminal proceedings, one does not evidence such as "beyond a reasonable doubt".
A personal injury lawyer, at a recent medical legal report writing workshop said the following:
"When completing your medical legal report, you will be asked for your opinion with respect to causation.
You will be required to opine on whether the negligent event, such as the automobile accident, caused the plaintiff to suffer the injuries he or she has or had.
Obviously, you must obtain a complete patient history from before and after the collision in order to provide an opinion on causation in most cases.
Your opinion on causation is as critical to a Medical Legal Report as is your diagnosis and prognosis. This is Tort Law and the legal system is required to attribute fault for the injury or harm.
Again, the threshold for causation is a balance of probabilities. Is it more likely than not that the collision caused the injuries or harm in question?
It is not therefore essential that the medical experts provide a firm opinion supporting the plaintiff's theory of causation. Medical experts ordinarily determine causation in terms of certainties whereas a lesser standard is demanded by the law.
Many doctors do not understand the phrase ... as they usually deal in "certainties" that are 100% sure, whereas "reasonable" certainties which the law requires need only be more probably so, i.e., 51%."
Thus, when asked to provide an opinion on causation, health care practitioners should not be thinking about medical causation but rather legal causation. An opinion, in the context of legal causation, is whether or not something is "more likely than not".
For further tips and hints on medical legal report writing register for the workshop:
Medical Legal Reports - The Essentials Saturday February 25 2017
Private Investor
8yGurdeep, your articles nails a key issue when it comes to physicians preparing a medical - legal opinions. You've very articulately identified the paradigm shift that a physician must embark upon when preparing an opinion. Science and hence medicine require certainty. In a civil action, the evidentiary standard is "on a balance of probabilities i.e. more likely than not. The distinction is one that many medical professional take time to embrace. Dr. Parhar, thank you so much for providing such a valuable service through your courses. Giving physicians the tools to prepare better opinions is of value to all concerned. But most importantly, it enables an injured person's condition to be examined with greater clarity.