WEBVTT
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Welcome to the Factor podcast, where we talk about the
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stuff they didn't teach you in school, how to grow
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your practice, refine your clinical skills, and get better results
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for your patients. We're here to help you navigate the
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real world challenges of being a healthcare provider, from delivering
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top notch patient care to running a business that doesn't
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run you into the ground. Whether you're fresh out of
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school or scaling your practice, we're diving into effective, cutting
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edge treatments to get patients better, faster. We'll also talk
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about business strategies and tactics to help you work smarter
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and not harder, and the mindset shifts required to thrive
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as a top performer in your field so you can
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build a career you love without burning out. If you're
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ready to learn what works and what doesn't from leading experts,
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industry innovators, and respected clinicians across a wide range of specialties,
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you're in the right place.
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My friend.
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Let's dive in. Welcome back to the Factor podcast, where
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we bridge the gap between rehabilitation performance and real world
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clinical practice. I'm your host, Jessica Riddle, and today we're
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kicking off a powerful two part conversation on a topic
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that many providers know is important, but let's be honest,
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most would rather not think about until they absolutely have to.
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We're talking about what happens when your clinical documentation, your
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treatment decisions, and your professional credibility enter the legal arena.
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Our guest today is doctor Pankti Fidia, a practicing chiropractor
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with more than eight years of clinical experience and personal
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injury care. She served as a clinical director and is
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practiced across Houston, San Antonio, Beaumont, and Las Vegas. In
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addition to her clinical work, doctor Fidia is also graduating
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soon from law school, actually within the month. With a
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focused interest in the intersection of health care and law,
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her work is dedicated to helping chiropractors better understand medico
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legal standards, strengthen their documentation, improve clinical credibility, and navigate
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the legal aspects of patient care with more confidence. In
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this first part of our training, doctor Fidilla will walk
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us through the personal injury case timeline. We'll talk about
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the difference between clinical causation and legal causation, why your
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documentation matters long before a case ever reaches a courtroom,
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and some of the most common charting mistakes. That can
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weaken your credibility, whether you treat personal injury cases every
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day or only occasionally encounter.
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Them in practice.
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This episode is a strong reminder that your notes are
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not just clinical records. In certain cases, they may become evidence.
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So if you've ever wondered how your documentation might hold
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up in a deposition, want to know a little more
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about what attorneys are really looking for, or know how
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to better protect both your patient and your professional credibility,
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this is an episode you'll want to listen to closely.
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Let's cue the intro music and get started.
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Thank you, Thank you Jessica for giving me this opportunity.
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This is my first time doing a live webinar, so
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welcome everyone. My name is doctor Pank Tifidia. I am
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a practicing catipractor. I do this full time Monday through
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Friday for past eight years and I love my job.
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And about three years ago I decided to go to
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law school because I want to transition to legal career,
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basically doing everything that I'm doing right now, but from
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the legal side. And so while we're going live right
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now or recording this, I am pending my bar examination
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this July. So if everything goes well, I will be
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a JD in a few months, and so it's an
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interesting journey. And when I started my legal career as
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a student, first I realized that there's this need for
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chiropractice to understand what happens when you're practicing chiropractic with
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respect to personal injury. So today's topic is from clinics
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to courtrooms and the goal is to give you an
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overview of what personal injury litigation is. A lot of
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us are thrown into practice. Once you graduate. You're just
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from chiropractic school and you're applying to jobs. The reality
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of our profession is that the high paying jobs are
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personal injury jobs, and so not a lot of us
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have the opportunity to pick what we want to do.
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Most of the times, students will just take whatever job
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they can get. And as an associate chiropractor, you don't
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know what your practice is going to be. It could
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be fifty percent health insurance cash, it could be fifty
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percent PI, or could be more than that. You just
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don't really know, and a lot of associates are switching jobs.
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In the initial here is trying to understand what they
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really like. And in that initial years you are going
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to come across a personal injury case, whether you own
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your own practice or you're working for somebody else an associate,
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this will happen, and it happened to me, And oftentimes
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what happens is once you switch jobs, you're done with
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that clinic, and a couple years later you get subpoena
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to appear for a case that a patient that you've
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seen for this particular clinic two years ago. You have
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no knowledge of what to do and how to proceed
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from here. So this lecture is an overview of what happens.
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So what can you do to be more prepared, whether
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that's giving depositions or testimony in court, or just the
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whole idea of what personal injury practice is from the
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legal perspective. So if you do this for a living,
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if ninety nine percent of your practice is personal injury,
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you will really find this lecture very helpful. And even
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if you don't do PI, at some point in your
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chiropractic career, you will come across attorneys. You will come
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across patients that never wanted to sue. An at fall
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driver came to you because they were hurting, later on
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changed their mind, and now you're stuck with the process anyway,
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So thank you so much for giving me your time.
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I know your time is valuable, and in the next
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fifteen minutes I'll try to touch on some important issues
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and then depending on your questions and if there is demand,
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we can go into more details into giving depositions and
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things like that down the road. So yeah, just a
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little bit about me. Like I told you, been practicing
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for eight nine years now and about to graduate law school.
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I have published two articles, which is really rare in
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our industry, so shout out to Parker University. My first
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article is for chiropractors, that's where this topic came from,
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and it is published in the Journal of Contemporary Chiropractic.
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That's the link if you guys want to check it out.
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Another way to find this is if you type my
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name in Google, the link pops up. And the second article,
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which is chiropractical evidence in an eighteen wheeler collision litigation
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from treatment to testimony. This one is in the Law
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Review Journal, which is a big thing if you are
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working in the legal side, So for lawyers that is
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a legal journal. It's prestigious and this article was designed
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and towards communicating to the legal community, the lawyers educating
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them what chiropractic is, how they can use chiropractic evidence
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in legal cases, how they can build our credibility, things
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like that, because as you're aware you're practicing chiropractor, that
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we're not only competing amongst ourselves to get business, we're
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also competing with the physical therapist community or medical doctors,
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and so a lot of the times outside our profession,
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attorneys are not aware of the things that we can
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bring on the table. So that was my goal to
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then communicate to the legal world and say, hey, I'm
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a chiropractor and I'm also going to be one of y'all.
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So I wrote this article and it's an honor to
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be able to communicate to doctors and also attorneys and
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bridge this gap. So why this matters? Like I said,
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your notes will end up in court. Matter whether you're
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practicing one hundred percent PI or you're just taking random
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ten twenty percent of your cases in your practice, or
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you're working for somebody else, sooner or later you will
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come across personal injury and so your notes will end
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up in court. And so we have to make sure
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that the minute we get a new patient intake two
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you're giving a testimony to the in the courtroom like
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you're prepared. Knowledge is power and confidence is the key,
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and how do you get that confidence? If you know
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what you're doing, it builds confidence. Attorneys will depend on
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your documentation. And when I say attorneys, I mean plaintiff attorneys.
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So this is we don't use the word plaintiff in defense.
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In practice, we just call them attorneys. But there are
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two types of attorneys. Of course, for every case, both
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sides are arguing using your notes. Plaintiff is patient, so
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patient's attorneys are plaintiff attorneys. They are the ones that
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are suing the at fault driver and their insurance company.
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And then there's defense attorneys. Defense attorneys are defending the
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insurance companies. And for us, defense attorneys are not our friends.
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They are the ones who are trying to use our
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notes and find everything that they can to make it
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sound like we're not credible, that we don't know what
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we're doing, that we're being dishonest, and we are lop driven,
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meaning that this whole scheme is made up and it's
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their job. So never take a defense attorney personally. Just
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understand that that's what they're doing. That's their job. And
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then there are plaintiff attorneys. Now you think that plaintiff
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attorneys are your friends, Well, they're better than the defense
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attorneys for sure, but they're also not your friends because
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their duty is towards the client, towards your patient, not
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towards you. But in day to day practice, when we
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say we work with attorneys, we work with plaintiff attorneys.
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These are the billboard attorneys that you see. These are
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the attorneys that will send you what's called an LOP,
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which is a letter of protection. So week records equals
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poor credibility in the legal world, when somebody is speaking
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as a witness, a jury or a judge is deciding
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whether or not that person is truthful, and it all
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goes down to credibility. For us Chiropractice, the way we
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prove that we're credible is through our notes. So, like
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I said, from intake paperwork, when you see the patient
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for the very first time to your last visit, that's
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where your entire universe of credibility exists. If it was
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not documented, it never happened. If you document things that
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you should not be documenting, it is going to get
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high and twisted and present it to the jury and
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the judge trying to attack that credibility. And I'll show
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you some things that you can do to increase the
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power of your documentation to sound more credible depending on
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the facts of the case. And every chiropractor has its
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own style, the own way of treating things like that.
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So you have to understand that you can't be me
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and I can't be you. But some of the things
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that we do as professionals in our education will give
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us a lot more power as compared to our counterparts,
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even medical doctors or pts, things like that. And last,
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but not the least, the lecture will also talk about
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how chiropractice can get in real trouble and I'm not
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talking about this PI case, but in general outside whether
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that's your license or getting in trouble with auto insurance companies.
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So the last of this lecture will focus on ethics.
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So let's talk about the PI case timeline. Most of
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the time, somebody will get into an accident, will hire
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an attorney, and if you work with them, that lawyer
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will send you an LOP and you're asked to schedule
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a patient. A patient will start treatment. This is pre
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litigation phase, meaning there's no ongoing case against any insurance company.
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This is where a lot of evidence is being gathered.
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That's where you come in. So all the patients that
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you're seeing while they're alive with you, the case is
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going to get into litigation. That's why your notes matter.
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But right now there's no pending case and that's all
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pre litigation. You'll hear that word a lot in practice
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pre lit pre litigation litigation meaning once you file paperwork
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in the court. At this point, the case is being litigated,
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meaning that it's actively being worth that in the court proceedings.
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So the treatment happens at your office. You may refer
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them out to other providers. They will go do whatever
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they need to do, and at some point the treatment
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will be done. This is when attorneys will often ask
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you to send bills and records, and so you do that.
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At that point, the lawyers, the plane of attorneys will
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make a demand letter it's like a packet, and they
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will send that to the insurance company. So you'll often
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hear that from the attorneys when you're in practice, that oh,
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we are sending a demand letter soon. We need everything
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right away. And these are the words that you'll hear
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a lot. So most cases, about ninety five percent of
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the cases that you will see will settle at this stage,
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maybe more than ninety five, let's just say ninety five.
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Approximately ninety five percent of the cases will be done.
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They'll settle. It's good. You will never have to worry
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about your documentation. Hopefully you get paid, but it's done.
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If not, the next stage is mediation and arbitration. This
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is again not litigation, but can get complicated depending on
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the jurisdiction that you're working under. But long story short, again,
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it's not full blown. Let's litigate this case in court.
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They're both arguing plain if attorneys trying to talk to
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the insurance adjusted at this point and trying to negotiate.
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So it's still mediation arbitration, this process where sometimes they
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the other side, meaning that there may be a defense attorney.
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At this point, both sides are meeting and trying to
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reach a resolution. Nobody wants to take cases to the court,
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even attorneys, because it's expensive, so people try to settle again,
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very likely at this stage, but sometimes negotiations fail. So
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now let's talk about litigation. You will know that a
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case is in litigation when you will start getting and
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I want to use this word harassment from a lot
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of third party records reach tribal companies. If you practice
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personal injury, you know what I'm talking about. For those
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who don't, you will start getting third party companies asking
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you for bills and records. And this is not from
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the patient's attorney side. This is just random. There's companies
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for that. So basically your defense side is hiring this
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third party records retribal companies and they'll start sending you
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subpoenis for documents and things like that. So you know, okay,
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this is your first time knowing that this particular case
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is in litigation. Besides that, there's no way for you
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to know that because you're so busy in your practice.
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You're not going to call the law firm and say, hey,
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what's going on with this? But once you start seeing that,
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you know that, Okay, maybe right now they're just asking
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for documentation, but if they don't settle, there may be
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a point in the future that I may have to
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go and testify either through deposition or in trial. Then
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comes the deposition segment again. Most other cases do settle,
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even in the early phases of litigation. But there's a
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process called discovery, meaning at this stage both parties are
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now exchanging evidence that they have and this is the
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time in a case where depositions are being taken. So
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there's two types of deposition. There's written deposition questions that
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you will receive, which is DWQ and it's mostly yes
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and no answers, or they may be asking you to
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produce records. Again, there's no live testimony here and catropractice
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are not afraid of this. It's normal business. Your staff
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can do all of that. They can answer the dwqs,
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they can do affidavits. Make sure you verify information. We
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want to know what information is being sent out by
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your staff. But it's not generally stressful. And then comes
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the time when you have to be the post. Now,
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if the plaintiff attorney meaning your patient's lawyer, wants you
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to give an expert testimony, they'll reach out to you,
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generally by an email. They'll ask you for an invoice.
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Make sure you build them for your time. And this
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is separate from whether or not the lawyer receives a
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settlement and then you get paid on the lob. This
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is separate. This is for your time to give a testimony,
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So that's plaintiff attorney usually asking you an email and
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you can negotiate your price per hour with them. All
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of that separately. They'll set a data side for you
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to present your deposition and we'll talk about depositions later.
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But sometimes you can get subpoena, meaning the other side
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will issue you a subpoena to compel you to testify.
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When that happens, it's not coming from your patient's attorney.
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It's coming from the other side, and they are not
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going to pay you for that practice tip that has
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happened to me. And whenever you get the subpoena, the
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somebody will come in deliver it to you and it
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will have on that subpoena. If you read it, it'll
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know who's doing who and you know that you're not
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party to the case because you're not being served, you're
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being subpoena. You're coming in as a witness, so your
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name's nowhere on the document, I mean, as far as
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parties are concerned. And then you'll see what they're asking
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in the subpoena. They're asking you to give an oral
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testimony and they may also ask you to bring documents
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and it'll have the lawyer's name on it, both for
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the plaintiff and the defense, so you know that this
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is coming from the other side and not from the
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patient's attorney. You can always email them and ask them
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to compensate you for your time. Again, it's hard because
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they are not legally required to pay you the defense side,
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but a lot of the times they'll say, sure, how
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much do you charge, and they'll negotiate with you, and
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then you can You can reach an agreement, but you
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have to do a little bit of persistence confidence and
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tell them you're busy, because we are busy. Again, settlement
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can reach at any stage. So they may set a
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date for you to do your deposition, but they can
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settle before that. They can settle right after your deposition.
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You never know when the case is going to get settled.
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Sometimes even before the jury, right after closing arguments, a
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case can settle. So settlements can happen at any stage,
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So just be mindful of that. Just because you're you
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have a trial date and you take time off of
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work and all of that, and you may even show
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up to the court and they settle that morning. So
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I always tell my chiropractor buddies, like, if you're going
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to go to court and you're taking time off, you
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have to ask for your money for your time, even
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if they settle. So that's something that you have to
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negotiate with. The plaintive side of the defense is not
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going to negotiate with you. They don't legally have to.
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But most of the time your planeif attorneys will say, sure,
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we understand things happen, so communicate with them in writing
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and make sure that you're compensated because this is not
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part of your lob this is extra and know your worth.
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All right, let's move on to tort law basics negligence.
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You will not hear these terms in practice, but it's
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good to understand what's going on. So when a driver
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messes up and causes an accident, you can bring a
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lawsuit against that driver and bring that insurance company into
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that case with the vehicle of negligence. That is the
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legal cause of action. And in order to prove negligence,
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a plantiff attorney has to prove four things, duty, breach, causation,
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and damages. Duty and breach is something that the lawyers
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have to worry about. So I'm not going to get
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into that, but just to explain you, duty would be
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it's my duty to be careful when I'm driving, and
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I breach that duty if I don't follow the rules,
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the traffic rules. So that's how they bring those elements
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and evidence for those elements in courtrooms where you and
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I are going to get challenged as chiropractors is causation
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and damages. So the other two buckets causation and damages,
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that's where majority of our testimony will come into play.
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Causation is the number one battleground. Every defense attorney will
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target you and your notes when it comes to causation.
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They want to make it sound like the accident did
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not cause this injury. Every case they'll say it's pre existing,
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it didn't happen from the accident, that we're exaggerating, or
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the client or the patient is exaggerating. That's what the
359
00:23:00.880 --> 00:23:03.920
defense will say every single time. It's a given. So
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causation is a battleground. You will use your notes to
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link causation. They will use your notes to make it
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sound like causation is poor or there's no documentation for causation.
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So remember, causation very important. A lot of the chiropractors
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don't document causation at all, and we'll get into that later.
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Damages again not battleground for sure, but not that difficult
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to prove. This is where your bills come into place.
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When they say bills and records, the records goes towards causation.
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The bills are now used to prove damages, and not
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only just your bills, but the entire whatever the patient did,
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whether any er record, any medical doctor, any anybody that
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they've seen. All that becomes past medical damages. Then there
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are other types of damages that the plaintiff can bring
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future there's past medical and there's future medical. This is
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when somebody is severely injured that they're going to need
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maybe twenty four to seven nursing facility, things like that.
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I'm just giving you examples, but there is also what's
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going to happen in the future. So past medical are
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00:24:17.880 --> 00:24:22.599
your bills. Future medical is speculative in so many ways,
379
00:24:22.640 --> 00:24:27.359
but a clever attorney will try to make that evidence
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come in and get compensation for what will happen in
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the future. There's other types of non economic economic damages,
382
00:24:37.240 --> 00:24:40.720
which again you don't need to know from your perspective,
383
00:24:41.200 --> 00:24:44.759
but it's always good to know overall what happens in
384
00:24:44.839 --> 00:24:52.319
a negligence case. So let's talk about causation. Clinical causation
385
00:24:52.480 --> 00:24:55.839
is very different from legal causation. So when what we
386
00:24:55.920 --> 00:25:01.279
study in school about causation, if somebody has ulopathy, then
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00:25:01.319 --> 00:25:04.160
you're thinking okay, and maybe a disc injury there, So
388
00:25:04.240 --> 00:25:12.599
that is your clinical causation. Legal causation is proving that
389
00:25:12.960 --> 00:25:17.440
whatever injury or symptoms this patient is presenting with is
390
00:25:17.720 --> 00:25:24.440
directly link to this particular accident. And it's easier said
391
00:25:24.480 --> 00:25:28.440
than done because clever defense attorney is well, like I said,
392
00:25:28.480 --> 00:25:31.400
they have AMMO. They will use everything in your notes,
393
00:25:31.920 --> 00:25:35.519
any kind of past medical history to say this is
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00:25:35.559 --> 00:25:38.960
pre existing, all sorts of stuff. So what can we
395
00:25:39.039 --> 00:25:47.720
do to make our documentation better? You have to link
396
00:25:47.920 --> 00:25:53.519
the injuries to the accident. So if somebody got into
397
00:25:53.559 --> 00:25:57.680
an accident yesterday and they presented with neck pain, don't
398
00:25:57.759 --> 00:26:00.240
just say they got into an accident. They came with
399
00:26:00.400 --> 00:26:04.599
neck pain today, because you see there is this missing
400
00:26:04.680 --> 00:26:06.559
piece of evidence there. You have to say they got
401
00:26:06.599 --> 00:26:09.960
into an accident on this particular date and because of
402
00:26:10.000 --> 00:26:14.839
that accident, they are presenting with pain today. So just
403
00:26:14.960 --> 00:26:20.240
simple word. Connecting those two sentences now helps your notes
404
00:26:20.279 --> 00:26:22.880
look better. As far as causation is concerned, that is,
405
00:26:22.920 --> 00:26:26.799
because of this accident, the patient is presenting with this symptoms,
406
00:26:27.279 --> 00:26:31.680
So causing, like the causation aspect, very very important. Document.
407
00:26:32.279 --> 00:26:34.960
Make sure you document mechanism of injury. A lot of
408
00:26:35.039 --> 00:26:38.119
us don't do that. We just say patient presents with
409
00:26:38.240 --> 00:26:43.440
neck pain, mechanism of injury because of car accident. Also,
410
00:26:43.640 --> 00:26:48.359
if there's any extremities involved for a regular spine injury,
411
00:26:48.480 --> 00:26:51.079
neck and back. It's sort of implied at this point
412
00:26:51.160 --> 00:26:54.799
that if somebody has a car accident injury, whiplash injury,
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00:26:55.359 --> 00:26:58.240
that it's neck and back. So we don't have to
414
00:26:58.960 --> 00:27:02.440
worry too much about explaining neck and back paid But
415
00:27:02.519 --> 00:27:06.200
if they have knee pain, shoulder pain, ankle pain, you
416
00:27:06.400 --> 00:27:10.279
have to go a step forward and document that why.
417
00:27:10.839 --> 00:27:14.839
So always good practice to ask your patients did you
418
00:27:14.920 --> 00:27:18.400
hit your knee to the dashboard or if they present
419
00:27:18.519 --> 00:27:22.200
with wrist pain, explain where was your arm or your
420
00:27:22.240 --> 00:27:25.319
hand was it on the steering wheel? What happened? Get
421
00:27:25.359 --> 00:27:29.319
that information from the patient and document it. If they
422
00:27:29.359 --> 00:27:32.039
give you that information, do it. If they say, oh,
423
00:27:32.519 --> 00:27:36.079
I don't remember but it hurts. Then you can always
424
00:27:36.160 --> 00:27:39.240
document that don't remember exactly what happened, the accident happened
425
00:27:39.240 --> 00:27:43.680
too fast, but did not have any pain before the accident,
426
00:27:43.759 --> 00:27:46.799
but now after the accident, they said that their risk
427
00:27:46.920 --> 00:27:51.680
is hurting, and so that helps. Be truthful, but be
428
00:27:51.839 --> 00:27:59.200
persuasive when you're writing now timing of symptom manifestation again
429
00:27:59.319 --> 00:28:02.960
link direct towards causation. It's important that most of the
430
00:28:03.039 --> 00:28:05.079
time it depends on the case. If you have a
431
00:28:05.160 --> 00:28:09.359
case that the accident happened recently and you saw them
432
00:28:09.720 --> 00:28:13.400
two or three weeks within that timeframe, it's implied the
433
00:28:13.400 --> 00:28:16.039
timing is easy. That's a good, good story. But you
434
00:28:16.279 --> 00:28:20.200
will get cases in practice that accident happened six months
435
00:28:20.240 --> 00:28:23.279
ago and they're having pain right now. There's not much
436
00:28:23.279 --> 00:28:26.039
you can do about that as far as documenting causation.
437
00:28:26.119 --> 00:28:29.079
But you can say, ask the patient, what did you
438
00:28:29.160 --> 00:28:32.920
do for this gap that six months? Did you treat
439
00:28:33.079 --> 00:28:36.319
at home? What happened? Why were you not able to
440
00:28:36.319 --> 00:28:39.680
get treatment sooner? Then they'll tell you, oh, I didn't
441
00:28:39.720 --> 00:28:42.559
have transportation, I didn't have that. It's okay to document that,
442
00:28:43.119 --> 00:28:46.000
Like I said, be truthful, but these are the questions
443
00:28:46.039 --> 00:28:48.599
that you can ask your patient and it'll make you
444
00:28:49.319 --> 00:28:54.359
not a regular chiropractor, but a well informed chiropractor who
445
00:28:54.440 --> 00:29:00.000
understands how to alleviate or increase the value of theirs.
446
00:29:00.359 --> 00:29:03.559
And so what you ask in your history matters. It's
447
00:29:03.640 --> 00:29:06.039
not a cookie cutter. Let me just ask all this
448
00:29:06.160 --> 00:29:10.240
accident questionnaire. No, no, no, think look at the date
449
00:29:10.279 --> 00:29:13.160
of the accident. See if there is gaps, try and
450
00:29:13.160 --> 00:29:15.079
see if you get information out of them to kind
451
00:29:15.079 --> 00:29:18.720
of connect causation there. It'll make your notes more valuable.
452
00:29:19.440 --> 00:29:26.160
Acute versus chronic symptoms, this is so common. Every defense
453
00:29:26.200 --> 00:29:29.200
attorney will say, this is not a cute, this is chronic.
454
00:29:29.240 --> 00:29:33.519
That's where you're orthopedic testing your palpatient skills. Everything will
455
00:29:33.559 --> 00:29:36.480
come into play here. Your doctors, you know how to
456
00:29:36.559 --> 00:29:41.720
document acute versus chronic, but also know that in real life,
457
00:29:42.400 --> 00:29:44.960
we get our plaintiffs the way we get them, meaning
458
00:29:45.000 --> 00:29:49.440
every patient will have pre existing conditions and it's okay.
459
00:29:50.359 --> 00:29:52.759
It's fine if they have car accidents in the past,
460
00:29:52.759 --> 00:29:55.640
it's okay to document that. But then you can also
461
00:29:55.720 --> 00:29:59.279
document sure they had accident previously, that there's a history
462
00:29:59.319 --> 00:30:03.000
of car accident, but they didn't have much pain before
463
00:30:03.039 --> 00:30:07.559
this accident, and this accident exacerbated their symptoms. So one
464
00:30:07.680 --> 00:30:11.400
sentence can now say, sure, my patient is sixty five
465
00:30:11.480 --> 00:30:14.799
years old and had some arthritic changes in this spine,
466
00:30:15.599 --> 00:30:18.880
but it's doing fine, and now after this wreck, and
467
00:30:18.920 --> 00:30:22.359
if they are feeling exacerbation of symptoms, and then say
468
00:30:22.400 --> 00:30:27.440
that document that. So connecting again to causation will help
469
00:30:27.480 --> 00:30:31.880
you make your notes stronger and that testimony is now
470
00:30:31.960 --> 00:30:35.559
backed up by your notes. History of past pain prior collisions,
471
00:30:35.839 --> 00:30:39.319
very very important. There's no such thing as hiding a
472
00:30:39.359 --> 00:30:41.720
bad fact. Like I said, a lot of our patients
473
00:30:41.759 --> 00:30:45.039
will have multiple corrects, or they're older, they've got other
474
00:30:45.680 --> 00:30:48.759
comorbidities and other issues going on. Defense will point at that,
475
00:30:48.839 --> 00:30:51.720
and it's fine let them. You can always say they
476
00:30:51.799 --> 00:30:56.440
had those issues, but this accident exacerbated their symptoms, which
477
00:30:56.799 --> 00:31:01.200
they did. And the next in line is that this
478
00:31:01.240 --> 00:31:08.839
particular phrase reasonable medical probability, very very important phrase every
479
00:31:08.880 --> 00:31:11.519
time a defense attorney asks you in person or in
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00:31:11.559 --> 00:31:15.880
trial or off the record, So doctor, are you sure?
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00:31:16.599 --> 00:31:20.200
Are you sure that this injury is caused by this
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00:31:20.279 --> 00:31:23.759
car wreck? Are you one hundred percent sure? Well, let
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00:31:23.759 --> 00:31:26.079
me tell you. Doctors, you don't have to be one
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00:31:26.119 --> 00:31:32.039
hundred percent sure. The legal standard is reasonable medical probability
485
00:31:32.880 --> 00:31:37.920
meaning more likely than not, meaning if you are about
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00:31:38.720 --> 00:31:43.160
seventy percent sure that this type of symptoms will manifest
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00:31:43.160 --> 00:31:46.960
after a car accident, you have everything that you need
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00:31:47.079 --> 00:31:49.599
to give that statement. You don't have to be one
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00:31:49.680 --> 00:31:53.200
hundred percent sure that all these injuries are because of
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00:31:53.240 --> 00:31:56.920
this accident. You just have to be more likely than
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00:31:56.960 --> 00:32:00.559
not sure. So the standard is reasonable medical probably and
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00:32:00.559 --> 00:32:03.559
that you can say that with confidence. No one can
493
00:32:03.599 --> 00:32:07.160
be one hundred percent sure. Can you be sure? You know, yeah,
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00:32:07.319 --> 00:32:13.759
I have reasonable medical probability that my patient's symptoms stem
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00:32:13.799 --> 00:32:24.440
from this particular injury.
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00:32:25.200 --> 00:32:27.680
That wraps up part one of our conversation with doctor
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00:32:27.720 --> 00:32:31.359
Pankti Fidia. In this episode, doctor Fidia gave us a
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00:32:31.400 --> 00:32:35.240
clear look at why personal injury documentation requires more than
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00:32:35.359 --> 00:32:39.000
just checking the right boxes. Your notes tell the story
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00:32:39.079 --> 00:32:42.680
of the patient's injury, the mechanism of injury, the progression
501
00:32:42.680 --> 00:32:46.160
of care, the clinical reasoning behind your treatment plan, and
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00:32:46.279 --> 00:32:50.799
ultimately it provides credibility for you as a provider. One
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00:32:50.799 --> 00:32:53.240
of the biggest takeaways from this first part is that
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00:32:53.319 --> 00:32:58.119
documentation is not just about proving what you did. It's
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00:32:58.160 --> 00:33:02.519
about clearly connecting the dots between the accident, the patient's symptoms,
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00:33:02.880 --> 00:33:07.079
your objective findings, your clinical decisions, and the patient's functional
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00:33:07.119 --> 00:33:12.839
progress over time. As doctor Fidia emphasized, causation is often
508
00:33:12.880 --> 00:33:16.720
one of the biggest battlegrounds in personal injury cases. That
509
00:33:16.920 --> 00:33:21.720
means the way you document history, mechanism of injury, symptom onset,
510
00:33:22.000 --> 00:33:26.839
pre existing conditions, functional limitations, gaps in care and treatment
511
00:33:26.880 --> 00:33:31.759
progression all matter. In Part two, we'll continue the conversation
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00:33:31.839 --> 00:33:37.519
by moving deeper into subpoenas, affidavits, depositions, trial testimony. We'll
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00:33:37.559 --> 00:33:41.920
talk about expert witness, credibility, and the ethical issues chiropractors
514
00:33:41.960 --> 00:33:44.359
need to be aware of when working within the personal
515
00:33:44.400 --> 00:33:48.839
injury space. So if this episode already has you mentally
516
00:33:48.880 --> 00:33:53.680
reviewing your own documentation habits good, that's the point. Better
517
00:33:53.720 --> 00:33:56.359
notes today can save you a world of stress later.
518
00:33:57.359 --> 00:33:59.759
If you found value in today's training, be shorre to
519
00:33:59.799 --> 00:34:02.400
lie follow and share it with a friend or a colleague,
520
00:34:02.920 --> 00:34:05.279
and check out the show notes for any special offers
521
00:34:05.279 --> 00:34:07.960
from our sponsors, along with a link to our website
522
00:34:07.960 --> 00:34:14.039
at factor podcast dot com. That's fak tr podcast dot com,
523
00:34:14.079 --> 00:34:16.639
where you can view a full transcript and get access
524
00:34:16.679 --> 00:34:19.639
to the recorded replay of this webinar. If you're more
525
00:34:19.639 --> 00:34:22.440
of a visual learner, be sure to join us for
526
00:34:22.480 --> 00:34:24.840
Part two, or we'll talk about what happens when your
527
00:34:24.880 --> 00:34:28.000
records are no longer just sitting in your EHR system.
528
00:34:28.440 --> 00:34:32.920
They're being examined, questioned, and potentially used in court. Part
529
00:34:32.920 --> 00:34:35.519
two drops in two weeks. We'll see you next time.
530
00:34:38.400 --> 00:34:40.320
Hey guys, if you like what you heard today, I
531
00:34:40.440 --> 00:34:43.960
encourage you to visit our website at Factor hyphenstore dot
532
00:34:44.000 --> 00:34:49.880
com that's spelled f a k tr hyphenstore dot com
533
00:34:50.079 --> 00:34:52.239
to find out more information about all that we have
534
00:34:52.360 --> 00:34:52.760
to offer.
535
00:34:52.960 --> 00:34:53.920
We have a variety of.
536
00:34:53.880 --> 00:34:56.880
Online offerings as well as our hands on Factor Rehab
537
00:34:56.920 --> 00:34:59.840
System course scheduled in cities around the globe. Be sure
538
00:34:59.840 --> 00:35:02.599
to also check out our event calendar and bookmark any
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of these upcoming live webinar dates coming up in the near.
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Future so you can join us live.
541
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And of course, the biggest compliment we can receive is
542
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for you to help us spread the word to your friends, colleagues,
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and classmates. You'll find all the important links, as well
544
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as info about our sponsors in the show notes, so
545
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be sure to check those out.
1
00:00:01.840 --> 00:00:04.679
Welcome to the Factor podcast, where we talk about the
2
00:00:04.719 --> 00:00:07.480
stuff they didn't teach you in school, how to grow
3
00:00:07.519 --> 00:00:10.720
your practice, refine your clinical skills, and get better results
4
00:00:10.759 --> 00:00:13.640
for your patients. We're here to help you navigate the
5
00:00:13.679 --> 00:00:17.280
real world challenges of being a healthcare provider, from delivering
6
00:00:17.320 --> 00:00:20.239
top notch patient care to running a business that doesn't
7
00:00:20.320 --> 00:00:23.039
run you into the ground. Whether you're fresh out of
8
00:00:23.079 --> 00:00:26.679
school or scaling your practice, we're diving into effective, cutting
9
00:00:26.800 --> 00:00:30.679
edge treatments to get patients better, faster. We'll also talk
10
00:00:30.679 --> 00:00:33.640
about business strategies and tactics to help you work smarter
11
00:00:33.759 --> 00:00:37.640
and not harder, and the mindset shifts required to thrive
12
00:00:37.759 --> 00:00:40.200
as a top performer in your field so you can
13
00:00:40.200 --> 00:00:43.479
build a career you love without burning out. If you're
14
00:00:43.520 --> 00:00:47.000
ready to learn what works and what doesn't from leading experts,
15
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industry innovators, and respected clinicians across a wide range of specialties,
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you're in the right place.
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My friend.
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Let's dive in. Welcome back to the Factor podcast, where
19
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we bridge the gap between rehabilitation performance and real world
20
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clinical practice. I'm your host, Jessica Riddle, and today we're
21
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kicking off a powerful two part conversation on a topic
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that many providers know is important, but let's be honest,
23
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most would rather not think about until they absolutely have to.
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We're talking about what happens when your clinical documentation, your
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treatment decisions, and your professional credibility enter the legal arena.
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Our guest today is doctor Pankti Fidia, a practicing chiropractor
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with more than eight years of clinical experience and personal
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injury care. She served as a clinical director and is
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practiced across Houston, San Antonio, Beaumont, and Las Vegas. In
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addition to her clinical work, doctor Fidia is also graduating
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soon from law school, actually within the month. With a
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focused interest in the intersection of health care and law,
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her work is dedicated to helping chiropractors better understand medico
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legal standards, strengthen their documentation, improve clinical credibility, and navigate
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the legal aspects of patient care with more confidence. In
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this first part of our training, doctor Fidilla will walk
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us through the personal injury case timeline. We'll talk about
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00:02:35.439 --> 00:02:39.680
the difference between clinical causation and legal causation, why your
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00:02:39.719 --> 00:02:43.520
documentation matters long before a case ever reaches a courtroom,
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00:02:43.919 --> 00:02:46.560
and some of the most common charting mistakes. That can
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weaken your credibility, whether you treat personal injury cases every
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day or only occasionally encounter.
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Them in practice.
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This episode is a strong reminder that your notes are
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not just clinical records. In certain cases, they may become evidence.
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00:03:03.039 --> 00:03:06.400
So if you've ever wondered how your documentation might hold
47
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up in a deposition, want to know a little more
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about what attorneys are really looking for, or know how
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to better protect both your patient and your professional credibility,
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this is an episode you'll want to listen to closely.
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Let's cue the intro music and get started.
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Thank you, Thank you Jessica for giving me this opportunity.
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This is my first time doing a live webinar, so
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welcome everyone. My name is doctor Pank Tifidia. I am
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a practicing catipractor. I do this full time Monday through
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Friday for past eight years and I love my job.
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And about three years ago I decided to go to
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law school because I want to transition to legal career,
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basically doing everything that I'm doing right now, but from
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the legal side. And so while we're going live right
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now or recording this, I am pending my bar examination
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this July. So if everything goes well, I will be
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a JD in a few months, and so it's an
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interesting journey. And when I started my legal career as
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a student, first I realized that there's this need for
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chiropractice to understand what happens when you're practicing chiropractic with
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respect to personal injury. So today's topic is from clinics
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to courtrooms and the goal is to give you an
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overview of what personal injury litigation is. A lot of
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us are thrown into practice. Once you graduate. You're just
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from chiropractic school and you're applying to jobs. The reality
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of our profession is that the high paying jobs are
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personal injury jobs, and so not a lot of us
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have the opportunity to pick what we want to do.
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Most of the times, students will just take whatever job
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they can get. And as an associate chiropractor, you don't
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know what your practice is going to be. It could
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be fifty percent health insurance cash, it could be fifty
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percent PI, or could be more than that. You just
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don't really know, and a lot of associates are switching jobs.
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In the initial here is trying to understand what they
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really like. And in that initial years you are going
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to come across a personal injury case, whether you own
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your own practice or you're working for somebody else an associate,
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this will happen, and it happened to me, And oftentimes
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what happens is once you switch jobs, you're done with
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that clinic, and a couple years later you get subpoena
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to appear for a case that a patient that you've
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seen for this particular clinic two years ago. You have
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no knowledge of what to do and how to proceed
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from here. So this lecture is an overview of what happens.
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So what can you do to be more prepared, whether
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that's giving depositions or testimony in court, or just the
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whole idea of what personal injury practice is from the
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legal perspective. So if you do this for a living,
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if ninety nine percent of your practice is personal injury,
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you will really find this lecture very helpful. And even
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if you don't do PI, at some point in your
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chiropractic career, you will come across attorneys. You will come
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across patients that never wanted to sue. An at fall
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driver came to you because they were hurting, later on
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changed their mind, and now you're stuck with the process anyway,
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So thank you so much for giving me your time.
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I know your time is valuable, and in the next
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fifteen minutes I'll try to touch on some important issues
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and then depending on your questions and if there is demand,
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we can go into more details into giving depositions and
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things like that down the road. So yeah, just a
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little bit about me. Like I told you, been practicing
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for eight nine years now and about to graduate law school.
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I have published two articles, which is really rare in
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our industry, so shout out to Parker University. My first
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article is for chiropractors, that's where this topic came from,
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and it is published in the Journal of Contemporary Chiropractic.
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That's the link if you guys want to check it out.
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Another way to find this is if you type my
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name in Google, the link pops up. And the second article,
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which is chiropractical evidence in an eighteen wheeler collision litigation
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from treatment to testimony. This one is in the Law
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Review Journal, which is a big thing if you are
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working in the legal side, So for lawyers that is
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a legal journal. It's prestigious and this article was designed
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and towards communicating to the legal community, the lawyers educating
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them what chiropractic is, how they can use chiropractic evidence
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in legal cases, how they can build our credibility, things
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like that, because as you're aware you're practicing chiropractor, that
127
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we're not only competing amongst ourselves to get business, we're
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also competing with the physical therapist community or medical doctors,
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and so a lot of the times outside our profession,
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attorneys are not aware of the things that we can
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bring on the table. So that was my goal to
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then communicate to the legal world and say, hey, I'm
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a chiropractor and I'm also going to be one of y'all.
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So I wrote this article and it's an honor to
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be able to communicate to doctors and also attorneys and
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bridge this gap. So why this matters? Like I said,
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your notes will end up in court. Matter whether you're
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00:09:01.799 --> 00:09:05.399
practicing one hundred percent PI or you're just taking random
139
00:09:05.440 --> 00:09:08.399
ten twenty percent of your cases in your practice, or
140
00:09:08.399 --> 00:09:11.720
you're working for somebody else, sooner or later you will
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00:09:11.759 --> 00:09:17.039
come across personal injury and so your notes will end
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up in court. And so we have to make sure
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that the minute we get a new patient intake two
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you're giving a testimony to the in the courtroom like
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00:09:27.440 --> 00:09:32.720
you're prepared. Knowledge is power and confidence is the key,
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00:09:33.080 --> 00:09:35.480
and how do you get that confidence? If you know
147
00:09:35.559 --> 00:09:40.919
what you're doing, it builds confidence. Attorneys will depend on
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your documentation. And when I say attorneys, I mean plaintiff attorneys.
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00:09:45.279 --> 00:09:48.919
So this is we don't use the word plaintiff in defense.
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In practice, we just call them attorneys. But there are
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two types of attorneys. Of course, for every case, both
152
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sides are arguing using your notes. Plaintiff is patient, so
153
00:10:00.039 --> 00:10:03.360
patient's attorneys are plaintiff attorneys. They are the ones that
154
00:10:03.440 --> 00:10:08.279
are suing the at fault driver and their insurance company.
155
00:10:08.720 --> 00:10:12.480
And then there's defense attorneys. Defense attorneys are defending the
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00:10:12.519 --> 00:10:17.240
insurance companies. And for us, defense attorneys are not our friends.
157
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They are the ones who are trying to use our
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notes and find everything that they can to make it
159
00:10:24.080 --> 00:10:28.399
sound like we're not credible, that we don't know what
160
00:10:28.440 --> 00:10:33.759
we're doing, that we're being dishonest, and we are lop driven,
161
00:10:34.559 --> 00:10:37.600
meaning that this whole scheme is made up and it's
162
00:10:37.679 --> 00:10:41.159
their job. So never take a defense attorney personally. Just
163
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understand that that's what they're doing. That's their job. And
164
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then there are plaintiff attorneys. Now you think that plaintiff
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attorneys are your friends, Well, they're better than the defense
166
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attorneys for sure, but they're also not your friends because
167
00:10:55.679 --> 00:10:59.320
their duty is towards the client, towards your patient, not
168
00:10:59.399 --> 00:11:04.120
towards you. But in day to day practice, when we
169
00:11:04.200 --> 00:11:07.799
say we work with attorneys, we work with plaintiff attorneys.
170
00:11:08.360 --> 00:11:10.639
These are the billboard attorneys that you see. These are
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00:11:10.639 --> 00:11:12.879
the attorneys that will send you what's called an LOP,
172
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which is a letter of protection. So week records equals
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poor credibility in the legal world, when somebody is speaking
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as a witness, a jury or a judge is deciding
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whether or not that person is truthful, and it all
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goes down to credibility. For us Chiropractice, the way we
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prove that we're credible is through our notes. So, like
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I said, from intake paperwork, when you see the patient
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for the very first time to your last visit, that's
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where your entire universe of credibility exists. If it was
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not documented, it never happened. If you document things that
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you should not be documenting, it is going to get
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high and twisted and present it to the jury and
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the judge trying to attack that credibility. And I'll show
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you some things that you can do to increase the
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power of your documentation to sound more credible depending on
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the facts of the case. And every chiropractor has its
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own style, the own way of treating things like that.
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So you have to understand that you can't be me
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and I can't be you. But some of the things
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that we do as professionals in our education will give
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us a lot more power as compared to our counterparts,
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even medical doctors or pts, things like that. And last,
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but not the least, the lecture will also talk about
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how chiropractice can get in real trouble and I'm not
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talking about this PI case, but in general outside whether
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that's your license or getting in trouble with auto insurance companies.
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So the last of this lecture will focus on ethics.
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So let's talk about the PI case timeline. Most of
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the time, somebody will get into an accident, will hire
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an attorney, and if you work with them, that lawyer
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will send you an LOP and you're asked to schedule
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a patient. A patient will start treatment. This is pre
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litigation phase, meaning there's no ongoing case against any insurance company.
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This is where a lot of evidence is being gathered.
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That's where you come in. So all the patients that
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you're seeing while they're alive with you, the case is
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going to get into litigation. That's why your notes matter.
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But right now there's no pending case and that's all
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pre litigation. You'll hear that word a lot in practice
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pre lit pre litigation litigation meaning once you file paperwork
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in the court. At this point, the case is being litigated,
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meaning that it's actively being worth that in the court proceedings.
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So the treatment happens at your office. You may refer
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them out to other providers. They will go do whatever
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they need to do, and at some point the treatment
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will be done. This is when attorneys will often ask
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you to send bills and records, and so you do that.
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At that point, the lawyers, the plane of attorneys will
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make a demand letter it's like a packet, and they
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will send that to the insurance company. So you'll often
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hear that from the attorneys when you're in practice, that oh,
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we are sending a demand letter soon. We need everything
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right away. And these are the words that you'll hear
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a lot. So most cases, about ninety five percent of
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the cases that you will see will settle at this stage,
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maybe more than ninety five, let's just say ninety five.
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Approximately ninety five percent of the cases will be done.
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They'll settle. It's good. You will never have to worry
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about your documentation. Hopefully you get paid, but it's done.
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If not, the next stage is mediation and arbitration. This
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is again not litigation, but can get complicated depending on
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the jurisdiction that you're working under. But long story short, again,
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it's not full blown. Let's litigate this case in court.
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They're both arguing plain if attorneys trying to talk to
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the insurance adjusted at this point and trying to negotiate.
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So it's still mediation arbitration, this process where sometimes they
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the other side, meaning that there may be a defense attorney.
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At this point, both sides are meeting and trying to
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reach a resolution. Nobody wants to take cases to the court,
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even attorneys, because it's expensive, so people try to settle again,
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very likely at this stage, but sometimes negotiations fail. So
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now let's talk about litigation. You will know that a
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case is in litigation when you will start getting and
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I want to use this word harassment from a lot
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of third party records reach tribal companies. If you practice
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personal injury, you know what I'm talking about. For those
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who don't, you will start getting third party companies asking
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you for bills and records. And this is not from
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the patient's attorney side. This is just random. There's companies
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for that. So basically your defense side is hiring this
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third party records retribal companies and they'll start sending you
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subpoenis for documents and things like that. So you know, okay,
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this is your first time knowing that this particular case
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is in litigation. Besides that, there's no way for you
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to know that because you're so busy in your practice.
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You're not going to call the law firm and say, hey,
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what's going on with this? But once you start seeing that,
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you know that, Okay, maybe right now they're just asking
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for documentation, but if they don't settle, there may be
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a point in the future that I may have to
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go and testify either through deposition or in trial. Then
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comes the deposition segment again. Most other cases do settle,
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even in the early phases of litigation. But there's a
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process called discovery, meaning at this stage both parties are
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now exchanging evidence that they have and this is the
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time in a case where depositions are being taken. So
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there's two types of deposition. There's written deposition questions that
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you will receive, which is DWQ and it's mostly yes
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and no answers, or they may be asking you to
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produce records. Again, there's no live testimony here and catropractice
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are not afraid of this. It's normal business. Your staff
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can do all of that. They can answer the dwqs,
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they can do affidavits. Make sure you verify information. We
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want to know what information is being sent out by
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your staff. But it's not generally stressful. And then comes
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the time when you have to be the post. Now,
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if the plaintiff attorney meaning your patient's lawyer, wants you
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to give an expert testimony, they'll reach out to you,
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generally by an email. They'll ask you for an invoice.
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Make sure you build them for your time. And this
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is separate from whether or not the lawyer receives a
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settlement and then you get paid on the lob. This
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is separate. This is for your time to give a testimony,
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So that's plaintiff attorney usually asking you an email and
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you can negotiate your price per hour with them. All
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of that separately. They'll set a data side for you
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to present your deposition and we'll talk about depositions later.
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But sometimes you can get subpoena, meaning the other side
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will issue you a subpoena to compel you to testify.
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When that happens, it's not coming from your patient's attorney.
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It's coming from the other side, and they are not
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going to pay you for that practice tip that has
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happened to me. And whenever you get the subpoena, the
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somebody will come in deliver it to you and it
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will have on that subpoena. If you read it, it'll
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know who's doing who and you know that you're not
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party to the case because you're not being served, you're
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being subpoena. You're coming in as a witness, so your
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name's nowhere on the document, I mean, as far as
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parties are concerned. And then you'll see what they're asking
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in the subpoena. They're asking you to give an oral
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testimony and they may also ask you to bring documents
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and it'll have the lawyer's name on it, both for
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the plaintiff and the defense, so you know that this
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is coming from the other side and not from the
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patient's attorney. You can always email them and ask them
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to compensate you for your time. Again, it's hard because
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they are not legally required to pay you the defense side,
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but a lot of the times they'll say, sure, how
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much do you charge, and they'll negotiate with you, and
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then you can You can reach an agreement, but you
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have to do a little bit of persistence confidence and
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tell them you're busy, because we are busy. Again, settlement
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can reach at any stage. So they may set a
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date for you to do your deposition, but they can
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settle before that. They can settle right after your deposition.
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You never know when the case is going to get settled.
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Sometimes even before the jury, right after closing arguments, a
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case can settle. So settlements can happen at any stage,
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So just be mindful of that. Just because you're you
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have a trial date and you take time off of
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work and all of that, and you may even show
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up to the court and they settle that morning. So
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I always tell my chiropractor buddies, like, if you're going
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to go to court and you're taking time off, you
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have to ask for your money for your time, even
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if they settle. So that's something that you have to
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negotiate with. The plaintive side of the defense is not
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going to negotiate with you. They don't legally have to.
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But most of the time your planeif attorneys will say, sure,
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we understand things happen, so communicate with them in writing
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and make sure that you're compensated because this is not
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part of your lob this is extra and know your worth.
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All right, let's move on to tort law basics negligence.
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You will not hear these terms in practice, but it's
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good to understand what's going on. So when a driver
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messes up and causes an accident, you can bring a
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lawsuit against that driver and bring that insurance company into
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that case with the vehicle of negligence. That is the
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legal cause of action. And in order to prove negligence,
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a plantiff attorney has to prove four things, duty, breach, causation,
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and damages. Duty and breach is something that the lawyers
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have to worry about. So I'm not going to get
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into that, but just to explain you, duty would be
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it's my duty to be careful when I'm driving, and
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I breach that duty if I don't follow the rules,
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the traffic rules. So that's how they bring those elements
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and evidence for those elements in courtrooms where you and
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I are going to get challenged as chiropractors is causation
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and damages. So the other two buckets causation and damages,
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that's where majority of our testimony will come into play.
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Causation is the number one battleground. Every defense attorney will
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target you and your notes when it comes to causation.
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They want to make it sound like the accident did
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not cause this injury. Every case they'll say it's pre existing,
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it didn't happen from the accident, that we're exaggerating, or
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the client or the patient is exaggerating. That's what the
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defense will say every single time. It's a given. So
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causation is a battleground. You will use your notes to
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link causation. They will use your notes to make it
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sound like causation is poor or there's no documentation for causation.
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So remember, causation very important. A lot of the chiropractors
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don't document causation at all, and we'll get into that later.
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Damages again not battleground for sure, but not that difficult
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to prove. This is where your bills come into place.
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When they say bills and records, the records goes towards causation.
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The bills are now used to prove damages, and not
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only just your bills, but the entire whatever the patient did,
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whether any er record, any medical doctor, any anybody that
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they've seen. All that becomes past medical damages. Then there
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are other types of damages that the plaintiff can bring
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future there's past medical and there's future medical. This is
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when somebody is severely injured that they're going to need
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maybe twenty four to seven nursing facility, things like that.
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I'm just giving you examples, but there is also what's
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going to happen in the future. So past medical are
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your bills. Future medical is speculative in so many ways,
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but a clever attorney will try to make that evidence
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come in and get compensation for what will happen in
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the future. There's other types of non economic economic damages,
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which again you don't need to know from your perspective,
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but it's always good to know overall what happens in
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a negligence case. So let's talk about causation. Clinical causation
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is very different from legal causation. So when what we
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study in school about causation, if somebody has ulopathy, then
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you're thinking okay, and maybe a disc injury there, So
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that is your clinical causation. Legal causation is proving that
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whatever injury or symptoms this patient is presenting with is
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directly link to this particular accident. And it's easier said
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than done because clever defense attorney is well, like I said,
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they have AMMO. They will use everything in your notes,
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any kind of past medical history to say this is
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pre existing, all sorts of stuff. So what can we
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do to make our documentation better? You have to link
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the injuries to the accident. So if somebody got into
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an accident yesterday and they presented with neck pain, don't
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just say they got into an accident. They came with
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neck pain today, because you see there is this missing
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piece of evidence there. You have to say they got
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into an accident on this particular date and because of
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that accident, they are presenting with pain today. So just
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simple word. Connecting those two sentences now helps your notes
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00:26:20.279 --> 00:26:22.880
look better. As far as causation is concerned, that is,
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because of this accident, the patient is presenting with this symptoms,
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So causing, like the causation aspect, very very important. Document.
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Make sure you document mechanism of injury. A lot of
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us don't do that. We just say patient presents with
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neck pain, mechanism of injury because of car accident. Also,
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if there's any extremities involved for a regular spine injury,
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neck and back. It's sort of implied at this point
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00:26:51.160 --> 00:26:54.799
that if somebody has a car accident injury, whiplash injury,
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00:26:55.359 --> 00:26:58.240
that it's neck and back. So we don't have to
414
00:26:58.960 --> 00:27:02.440
worry too much about explaining neck and back paid But
415
00:27:02.519 --> 00:27:06.200
if they have knee pain, shoulder pain, ankle pain, you
416
00:27:06.400 --> 00:27:10.279
have to go a step forward and document that why.
417
00:27:10.839 --> 00:27:14.839
So always good practice to ask your patients did you
418
00:27:14.920 --> 00:27:18.400
hit your knee to the dashboard or if they present
419
00:27:18.519 --> 00:27:22.200
with wrist pain, explain where was your arm or your
420
00:27:22.240 --> 00:27:25.319
hand was it on the steering wheel? What happened? Get
421
00:27:25.359 --> 00:27:29.319
that information from the patient and document it. If they
422
00:27:29.359 --> 00:27:32.039
give you that information, do it. If they say, oh,
423
00:27:32.519 --> 00:27:36.079
I don't remember but it hurts. Then you can always
424
00:27:36.160 --> 00:27:39.240
document that don't remember exactly what happened, the accident happened
425
00:27:39.240 --> 00:27:43.680
too fast, but did not have any pain before the accident,
426
00:27:43.759 --> 00:27:46.799
but now after the accident, they said that their risk
427
00:27:46.920 --> 00:27:51.680
is hurting, and so that helps. Be truthful, but be
428
00:27:51.839 --> 00:27:59.200
persuasive when you're writing now timing of symptom manifestation again
429
00:27:59.319 --> 00:28:02.960
link direct towards causation. It's important that most of the
430
00:28:03.039 --> 00:28:05.079
time it depends on the case. If you have a
431
00:28:05.160 --> 00:28:09.359
case that the accident happened recently and you saw them
432
00:28:09.720 --> 00:28:13.400
two or three weeks within that timeframe, it's implied the
433
00:28:13.400 --> 00:28:16.039
timing is easy. That's a good, good story. But you
434
00:28:16.279 --> 00:28:20.200
will get cases in practice that accident happened six months
435
00:28:20.240 --> 00:28:23.279
ago and they're having pain right now. There's not much
436
00:28:23.279 --> 00:28:26.039
you can do about that as far as documenting causation.
437
00:28:26.119 --> 00:28:29.079
But you can say, ask the patient, what did you
438
00:28:29.160 --> 00:28:32.920
do for this gap that six months? Did you treat
439
00:28:33.079 --> 00:28:36.319
at home? What happened? Why were you not able to
440
00:28:36.319 --> 00:28:39.680
get treatment sooner? Then they'll tell you, oh, I didn't
441
00:28:39.720 --> 00:28:42.559
have transportation, I didn't have that. It's okay to document that,
442
00:28:43.119 --> 00:28:46.000
Like I said, be truthful, but these are the questions
443
00:28:46.039 --> 00:28:48.599
that you can ask your patient and it'll make you
444
00:28:49.319 --> 00:28:54.359
not a regular chiropractor, but a well informed chiropractor who
445
00:28:54.440 --> 00:29:00.000
understands how to alleviate or increase the value of theirs.
446
00:29:00.359 --> 00:29:03.559
And so what you ask in your history matters. It's
447
00:29:03.640 --> 00:29:06.039
not a cookie cutter. Let me just ask all this
448
00:29:06.160 --> 00:29:10.240
accident questionnaire. No, no, no, think look at the date
449
00:29:10.279 --> 00:29:13.160
of the accident. See if there is gaps, try and
450
00:29:13.160 --> 00:29:15.079
see if you get information out of them to kind
451
00:29:15.079 --> 00:29:18.720
of connect causation there. It'll make your notes more valuable.
452
00:29:19.440 --> 00:29:26.160
Acute versus chronic symptoms, this is so common. Every defense
453
00:29:26.200 --> 00:29:29.200
attorney will say, this is not a cute, this is chronic.
454
00:29:29.240 --> 00:29:33.519
That's where you're orthopedic testing your palpatient skills. Everything will
455
00:29:33.559 --> 00:29:36.480
come into play here. Your doctors, you know how to
456
00:29:36.559 --> 00:29:41.720
document acute versus chronic, but also know that in real life,
457
00:29:42.400 --> 00:29:44.960
we get our plaintiffs the way we get them, meaning
458
00:29:45.000 --> 00:29:49.440
every patient will have pre existing conditions and it's okay.
459
00:29:50.359 --> 00:29:52.759
It's fine if they have car accidents in the past,
460
00:29:52.759 --> 00:29:55.640
it's okay to document that. But then you can also
461
00:29:55.720 --> 00:29:59.279
document sure they had accident previously, that there's a history
462
00:29:59.319 --> 00:30:03.000
of car accident, but they didn't have much pain before
463
00:30:03.039 --> 00:30:07.559
this accident, and this accident exacerbated their symptoms. So one
464
00:30:07.680 --> 00:30:11.400
sentence can now say, sure, my patient is sixty five
465
00:30:11.480 --> 00:30:14.799
years old and had some arthritic changes in this spine,
466
00:30:15.599 --> 00:30:18.880
but it's doing fine, and now after this wreck, and
467
00:30:18.920 --> 00:30:22.359
if they are feeling exacerbation of symptoms, and then say
468
00:30:22.400 --> 00:30:27.440
that document that. So connecting again to causation will help
469
00:30:27.480 --> 00:30:31.880
you make your notes stronger and that testimony is now
470
00:30:31.960 --> 00:30:35.559
backed up by your notes. History of past pain prior collisions,
471
00:30:35.839 --> 00:30:39.319
very very important. There's no such thing as hiding a
472
00:30:39.359 --> 00:30:41.720
bad fact. Like I said, a lot of our patients
473
00:30:41.759 --> 00:30:45.039
will have multiple corrects, or they're older, they've got other
474
00:30:45.680 --> 00:30:48.759
comorbidities and other issues going on. Defense will point at that,
475
00:30:48.839 --> 00:30:51.720
and it's fine let them. You can always say they
476
00:30:51.799 --> 00:30:56.440
had those issues, but this accident exacerbated their symptoms, which
477
00:30:56.799 --> 00:31:01.200
they did. And the next in line is that this
478
00:31:01.240 --> 00:31:08.839
particular phrase reasonable medical probability, very very important phrase every
479
00:31:08.880 --> 00:31:11.519
time a defense attorney asks you in person or in
480
00:31:11.559 --> 00:31:15.880
trial or off the record, So doctor, are you sure?
481
00:31:16.599 --> 00:31:20.200
Are you sure that this injury is caused by this
482
00:31:20.279 --> 00:31:23.759
car wreck? Are you one hundred percent sure? Well, let
483
00:31:23.759 --> 00:31:26.079
me tell you. Doctors, you don't have to be one
484
00:31:26.119 --> 00:31:32.039
hundred percent sure. The legal standard is reasonable medical probability
485
00:31:32.880 --> 00:31:37.920
meaning more likely than not, meaning if you are about
486
00:31:38.720 --> 00:31:43.160
seventy percent sure that this type of symptoms will manifest
487
00:31:43.160 --> 00:31:46.960
after a car accident, you have everything that you need
488
00:31:47.079 --> 00:31:49.599
to give that statement. You don't have to be one
489
00:31:49.680 --> 00:31:53.200
hundred percent sure that all these injuries are because of
490
00:31:53.240 --> 00:31:56.920
this accident. You just have to be more likely than
491
00:31:56.960 --> 00:32:00.559
not sure. So the standard is reasonable medical probably and
492
00:32:00.559 --> 00:32:03.559
that you can say that with confidence. No one can
493
00:32:03.599 --> 00:32:07.160
be one hundred percent sure. Can you be sure? You know, yeah,
494
00:32:07.319 --> 00:32:13.759
I have reasonable medical probability that my patient's symptoms stem
495
00:32:13.799 --> 00:32:24.440
from this particular injury.
496
00:32:25.200 --> 00:32:27.680
That wraps up part one of our conversation with doctor
497
00:32:27.720 --> 00:32:31.359
Pankti Fidia. In this episode, doctor Fidia gave us a
498
00:32:31.400 --> 00:32:35.240
clear look at why personal injury documentation requires more than
499
00:32:35.359 --> 00:32:39.000
just checking the right boxes. Your notes tell the story
500
00:32:39.079 --> 00:32:42.680
of the patient's injury, the mechanism of injury, the progression
501
00:32:42.680 --> 00:32:46.160
of care, the clinical reasoning behind your treatment plan, and
502
00:32:46.279 --> 00:32:50.799
ultimately it provides credibility for you as a provider. One
503
00:32:50.799 --> 00:32:53.240
of the biggest takeaways from this first part is that
504
00:32:53.319 --> 00:32:58.119
documentation is not just about proving what you did. It's
505
00:32:58.160 --> 00:33:02.519
about clearly connecting the dots between the accident, the patient's symptoms,
506
00:33:02.880 --> 00:33:07.079
your objective findings, your clinical decisions, and the patient's functional
507
00:33:07.119 --> 00:33:12.839
progress over time. As doctor Fidia emphasized, causation is often
508
00:33:12.880 --> 00:33:16.720
one of the biggest battlegrounds in personal injury cases. That
509
00:33:16.920 --> 00:33:21.720
means the way you document history, mechanism of injury, symptom onset,
510
00:33:22.000 --> 00:33:26.839
pre existing conditions, functional limitations, gaps in care and treatment
511
00:33:26.880 --> 00:33:31.759
progression all matter. In Part two, we'll continue the conversation
512
00:33:31.839 --> 00:33:37.519
by moving deeper into subpoenas, affidavits, depositions, trial testimony. We'll
513
00:33:37.559 --> 00:33:41.920
talk about expert witness, credibility, and the ethical issues chiropractors
514
00:33:41.960 --> 00:33:44.359
need to be aware of when working within the personal
515
00:33:44.400 --> 00:33:48.839
injury space. So if this episode already has you mentally
516
00:33:48.880 --> 00:33:53.680
reviewing your own documentation habits good, that's the point. Better
517
00:33:53.720 --> 00:33:56.359
notes today can save you a world of stress later.
518
00:33:57.359 --> 00:33:59.759
If you found value in today's training, be shorre to
519
00:33:59.799 --> 00:34:02.400
lie follow and share it with a friend or a colleague,
520
00:34:02.920 --> 00:34:05.279
and check out the show notes for any special offers
521
00:34:05.279 --> 00:34:07.960
from our sponsors, along with a link to our website
522
00:34:07.960 --> 00:34:14.039
at factor podcast dot com. That's fak tr podcast dot com,
523
00:34:14.079 --> 00:34:16.639
where you can view a full transcript and get access
524
00:34:16.679 --> 00:34:19.639
to the recorded replay of this webinar. If you're more
525
00:34:19.639 --> 00:34:22.440
of a visual learner, be sure to join us for
526
00:34:22.480 --> 00:34:24.840
Part two, or we'll talk about what happens when your
527
00:34:24.880 --> 00:34:28.000
records are no longer just sitting in your EHR system.
528
00:34:28.440 --> 00:34:32.920
They're being examined, questioned, and potentially used in court. Part
529
00:34:32.920 --> 00:34:35.519
two drops in two weeks. We'll see you next time.
530
00:34:38.400 --> 00:34:40.320
Hey guys, if you like what you heard today, I
531
00:34:40.440 --> 00:34:43.960
encourage you to visit our website at Factor hyphenstore dot
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00:34:44.000 --> 00:34:49.880
com that's spelled f a k tr hyphenstore dot com
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00:34:50.079 --> 00:34:52.239
to find out more information about all that we have
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00:34:52.360 --> 00:34:52.760
to offer.
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00:34:52.960 --> 00:34:53.920
We have a variety of.
536
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Online offerings as well as our hands on Factor Rehab
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System course scheduled in cities around the globe. Be sure
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00:34:59.840 --> 00:35:02.599
to also check out our event calendar and bookmark any
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of these upcoming live webinar dates coming up in the near.
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Future so you can join us live.
541
00:35:07.360 --> 00:35:09.800
And of course, the biggest compliment we can receive is
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for you to help us spread the word to your friends, colleagues,
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and classmates. You'll find all the important links, as well
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as info about our sponsors in the show notes, so
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be sure to check those out.
