WEBVTT
1
00:00:01.520 --> 00:00:04.320
Welcome to the Factor Podcast, where we talk about the
2
00:00:04.360 --> 00:00:07.080
stuff they didn't teach you in school, how to grow
3
00:00:07.160 --> 00:00:10.359
your practice, refine your clinical skills, and get better results
4
00:00:10.400 --> 00:00:13.279
for your patients. We're here to help you navigate the
5
00:00:13.320 --> 00:00:16.920
real world challenges of being a healthcare provider, from delivering
6
00:00:17.000 --> 00:00:19.920
top notch patient care to running a business that doesn't
7
00:00:19.960 --> 00:00:22.719
run you into the ground. Whether you're fresh out of
8
00:00:22.719 --> 00:00:26.320
school or scaling your practice, we're diving into effective, cutting
9
00:00:26.440 --> 00:00:27.719
edge treatments.
10
00:00:27.239 --> 00:00:28.839
To get patients better, faster.
11
00:00:29.600 --> 00:00:32.560
We'll also talk about business strategies and tactics to help
12
00:00:32.600 --> 00:00:35.840
you work smarter and not harder, and the mindset shifts
13
00:00:35.880 --> 00:00:39.119
required to thrive as a top performer in your field
14
00:00:39.439 --> 00:00:42.000
so you can build a career you love without burning out.
15
00:00:42.840 --> 00:00:45.240
If you're ready to learn what works and what doesn't
16
00:00:45.520 --> 00:00:49.679
from leading experts, industry innovators, and respected clinicians across a
17
00:00:49.759 --> 00:00:52.920
wide range of specialties, you're in the right place.
18
00:00:52.640 --> 00:01:09.640
My friend. Let's dive in.
19
00:01:15.200 --> 00:01:17.680
Welcome back to the Factor podcast. Will we bridge the
20
00:01:17.719 --> 00:01:22.680
gap between rehabilitation performance and real world clinical practice. I'm
21
00:01:22.719 --> 00:01:26.040
your host, Jessica Riddle, and today we're continuing our two
22
00:01:26.120 --> 00:01:31.439
part conversation with doctor Pankte Fidia, DC MBA on what
23
00:01:31.560 --> 00:01:34.560
chiropractors need to know when clinical care intersects with the
24
00:01:34.640 --> 00:01:38.959
legal system. In Part one, doctor Fidia helped us understand
25
00:01:39.000 --> 00:01:43.920
the personal injury case timeline, the importance of documentation, the
26
00:01:44.000 --> 00:01:48.439
difference between clinical and legal causation, and why your notes
27
00:01:48.480 --> 00:01:53.120
may eventually become much more than clinical records. In Part two,
28
00:01:53.560 --> 00:01:57.879
we'll move deeper into what happens when those records are requested, questioned,
29
00:01:58.040 --> 00:02:02.040
or used in legal proceedings. Doctor Fidilla will walk us
30
00:02:02.079 --> 00:02:08.400
through subpoenas, affidavits, depositions, trial testimony, and the ethical issues
31
00:02:08.479 --> 00:02:11.280
chiropractors need to be aware of on working in the
32
00:02:11.360 --> 00:02:16.039
personal injury space. Shall also share practical advice for providers
33
00:02:16.039 --> 00:02:18.599
who may one day be asked to defend their documentation,
34
00:02:19.159 --> 00:02:23.319
explain their treatment decisions, or provide testimony regarding a patient's care.
35
00:02:24.439 --> 00:02:27.560
And one of the biggest themes in this episode is confidence,
36
00:02:28.080 --> 00:02:32.120
not arrogance, not overstepping your scope, and definitely not trying
37
00:02:32.120 --> 00:02:35.560
to play attorney, but the kind of professional confidence that
38
00:02:35.599 --> 00:02:39.960
comes from knowing your notes, understanding your role, and standing behind.
39
00:02:39.639 --> 00:02:40.759
The care you provided.
40
00:02:41.800 --> 00:02:46.120
Whether you regularly treat personal injury patients or only occasionally
41
00:02:46.199 --> 00:02:50.039
encounter these cases in practice. This conversation is a valuable
42
00:02:50.080 --> 00:02:54.439
reminder that preparation matters because when your documentation enters the
43
00:02:54.520 --> 00:03:01.039
legal arena, clarity, credibility, and professionalism can make all the difference. Now,
44
00:03:01.439 --> 00:03:04.159
let's get into part two of Clinics to Courtrooms with
45
00:03:04.280 --> 00:03:14.039
doctor pankt Fida.
46
00:03:15.479 --> 00:03:20.000
So let's talk about the PI case timeline. Most of
47
00:03:20.039 --> 00:03:23.599
the time, somebody will get into an accident, will hire
48
00:03:23.599 --> 00:03:26.520
an attorney, and if you work with them, that lawyer
49
00:03:26.680 --> 00:03:29.680
will send you an LOP and you're asked to schedule
50
00:03:29.759 --> 00:03:33.240
a patient, a patient will start treatment. This is pre
51
00:03:33.319 --> 00:03:38.719
litigation phase, meaning there's no ongoing case against any insurance company.
52
00:03:38.719 --> 00:03:40.960
This is where a lot of evidence is being gathered.
53
00:03:41.520 --> 00:03:44.039
That's where you come in. So all the patients that
54
00:03:44.080 --> 00:03:47.879
you're seeing while they're alive with you, the case is
55
00:03:47.919 --> 00:03:50.560
going to get into litigation. That's why your notes matter.
56
00:03:50.680 --> 00:03:53.240
But right now there's no pending case and that's all
57
00:03:53.280 --> 00:03:56.039
pre litigation. You'll hear that word a lot in practice,
58
00:03:56.199 --> 00:04:00.960
pre lit pre litigation litigation meaning once you file paperwork
59
00:04:01.000 --> 00:04:04.120
in the court. At this point, the case is being litigated,
60
00:04:04.199 --> 00:04:08.159
meaning that it's actively being worked out in the court proceedings.
61
00:04:09.000 --> 00:04:12.360
So the treatment happens at your office. You may refer
62
00:04:12.400 --> 00:04:15.520
them out to other providers. They will go do whatever
63
00:04:15.599 --> 00:04:18.439
they need to do, and at some point the treatment
64
00:04:18.839 --> 00:04:22.920
will be done. This is when attorneys will often ask
65
00:04:23.000 --> 00:04:26.360
you to send bills and records, and so you do that.
66
00:04:26.959 --> 00:04:29.800
At that point, the lawyers, the plane of attorneys will
67
00:04:29.800 --> 00:04:33.439
make a demand letter it's like a packet, and they
68
00:04:33.480 --> 00:04:36.920
will send that to the insurance company. So you'll often
69
00:04:36.959 --> 00:04:39.639
hear that from the attorneys when you're in practice, that oh,
70
00:04:39.639 --> 00:04:42.000
we are sending a demand letter soon. We need everything
71
00:04:42.079 --> 00:04:44.920
right away. And these are the words that you'll hear
72
00:04:44.959 --> 00:04:50.399
a lot. So most cases, about ninety five percent of
73
00:04:50.439 --> 00:04:54.160
the cases will that you will see will settle at
74
00:04:54.160 --> 00:04:58.160
this stage, maybe more than ninety five, let's just say
75
00:04:58.240 --> 00:05:01.240
ninety five. Approximately ninety five percent of the cases will
76
00:05:01.920 --> 00:05:04.759
be done. They'll settle. It's good. You will never have
77
00:05:04.839 --> 00:05:09.240
to worry about your documentation. Hopefully you get paid, but
78
00:05:09.600 --> 00:05:14.480
it's done. If not, the next stage is mediation and arbitration.
79
00:05:15.879 --> 00:05:19.240
This is again not litigation, but can get complicated depending
80
00:05:19.240 --> 00:05:22.160
on the jurisdiction that you're working under. But long story
81
00:05:22.240 --> 00:05:25.720
short again, it's not full blown. Let's litigate this case
82
00:05:25.759 --> 00:05:29.759
in court. They're both arguing, plain of attorneys trying to
83
00:05:29.759 --> 00:05:32.639
talk to the insurance adjusted at this point and trying
84
00:05:32.680 --> 00:05:37.079
to negotiate. So it's still mediation arbitration, this process where
85
00:05:37.319 --> 00:05:40.079
sometimes the other side, meaning that there may be a
86
00:05:40.120 --> 00:05:43.040
defense attorney at this point, both sides are meeting and
87
00:05:43.160 --> 00:05:46.439
trying to reach a resolution. Nobody wants to take cases
88
00:05:46.480 --> 00:05:50.120
to the court, even attorneys, because it's expensive, so people
89
00:05:50.199 --> 00:05:53.600
try to settle again very likely at this stage, but
90
00:05:54.079 --> 00:05:59.199
sometimes negotiations fail. So now let's talk about litigation. You
91
00:05:59.279 --> 00:06:02.120
will know that a case is in litigation when you
92
00:06:02.160 --> 00:06:05.439
will start getting and I want to use this word
93
00:06:05.480 --> 00:06:11.279
harassment from a lot of third party records retribal companies.
94
00:06:11.800 --> 00:06:14.759
If you practice personal injury, you know what I'm talking about.
95
00:06:14.920 --> 00:06:19.160
For those who don't, you will start getting third party
96
00:06:19.199 --> 00:06:23.360
companies asking you for bills and records. And this is
97
00:06:23.399 --> 00:06:27.879
not from the patient's attorney side, This is just random.
98
00:06:27.920 --> 00:06:31.120
There's companies for that. So basically your defense side is
99
00:06:31.240 --> 00:06:35.120
hiring this third party records retribal companies and they'll start
100
00:06:35.160 --> 00:06:39.639
sending you subpoenas for documents and things like that. So
101
00:06:39.759 --> 00:06:43.319
you know, okay, this is your first time knowing that
102
00:06:43.439 --> 00:06:48.160
this particular case is in litigation. Besides that, there's no
103
00:06:48.240 --> 00:06:50.439
way for you to know that because you're so busy
104
00:06:50.480 --> 00:06:52.279
in your practice. You're not going to call the law
105
00:06:52.319 --> 00:06:54.639
firm and say, hey, what's going on with this? But
106
00:06:54.720 --> 00:06:58.360
once you start seeing that, you know that, Okay, maybe
107
00:06:58.800 --> 00:07:01.319
right now they're just asking for documentation, but if they
108
00:07:01.360 --> 00:07:04.680
don't settle, there may be a point in the future
109
00:07:04.759 --> 00:07:08.399
that I may have to go and testify, either through
110
00:07:08.439 --> 00:07:14.600
deposition or in trial. Then comes the deposition segment again.
111
00:07:14.879 --> 00:07:18.600
Most other cases do settle, even in the early phases
112
00:07:18.639 --> 00:07:23.319
of litigation. But there is a process called discovery, meaning
113
00:07:23.759 --> 00:07:28.879
at this stage both parties are now exchanging evidence that
114
00:07:28.959 --> 00:07:32.480
they have and this is the time in a case
115
00:07:32.680 --> 00:07:38.040
where depositions are being taken. So there's two types of deposition.
116
00:07:39.240 --> 00:07:42.560
There's written deposition questions that you will receive, which is
117
00:07:42.639 --> 00:07:47.560
DWQ and it's mostly yes and no answers, or they
118
00:07:47.600 --> 00:07:51.240
may be asking you to produce records. Again, there's no
119
00:07:51.399 --> 00:07:54.519
live testimony here, and Catropractice are not afraid of this.
120
00:07:55.199 --> 00:07:57.519
It's normal business. Your staff can do all of that.
121
00:07:57.720 --> 00:08:02.000
They can answer the DWQS. They can do affidavits. Make
122
00:08:02.040 --> 00:08:04.959
sure you verify information. We want to know what information
123
00:08:05.000 --> 00:08:08.319
is being sent out by your staff. But it's not
124
00:08:08.480 --> 00:08:12.600
generally stressful and then comes the time when you have
125
00:08:12.680 --> 00:08:15.519
to be the post. Now, if the plaintiff attorney meaning
126
00:08:15.560 --> 00:08:20.160
your patient's lawyer, wants you to give an expert testimony,
127
00:08:20.199 --> 00:08:23.240
they'll reach out to you, generally via email. They'll ask
128
00:08:23.279 --> 00:08:26.199
you for an invoice, make sure you build them for
129
00:08:26.279 --> 00:08:29.959
your time. And this is separate from whether or not
130
00:08:30.560 --> 00:08:33.360
the lawyer receives a settlement and then you get paid
131
00:08:33.399 --> 00:08:35.320
on the lop. This is separate. This is for your
132
00:08:35.320 --> 00:08:39.320
time to give a testimony. So that's plaintiff attorney usually
133
00:08:39.360 --> 00:08:43.240
asking you an email, and you can negotiate your price
134
00:08:43.360 --> 00:08:46.679
per hour with them. All of that separately. They'll set
135
00:08:46.679 --> 00:08:50.679
a data side for you to present your deposition and
136
00:08:50.759 --> 00:08:54.639
we'll talk about depositions later. But sometimes you can get subpoena,
137
00:08:55.480 --> 00:08:58.759
meaning the other side will issue you a subpoena to
138
00:08:59.039 --> 00:09:04.679
compel you to testify. When that happens, it's not coming
139
00:09:04.720 --> 00:09:08.559
from your patient's attorney, it's coming from the other side,
140
00:09:09.639 --> 00:09:12.120
and they are not going to pay you for that.
141
00:09:12.799 --> 00:09:17.320
Practice tip that has happened to me and I. Whenever
142
00:09:17.360 --> 00:09:20.879
you get the subpoena, they somebody will come in deliver
143
00:09:21.000 --> 00:09:23.879
it to you and it will have on that subpoena.
144
00:09:23.879 --> 00:09:26.919
If you read it, it'll know who's doing who. And
145
00:09:26.960 --> 00:09:29.399
you know that you're not party to the case because
146
00:09:29.440 --> 00:09:31.720
you're not being served, you're being subpoena. You're coming in
147
00:09:31.759 --> 00:09:35.159
as a witness, so your name's nowhere on the document,
148
00:09:35.639 --> 00:09:37.759
I mean, as far as parties are concerned. And then
149
00:09:37.799 --> 00:09:40.399
you'll see what they're asking in the subpoena. They're asking
150
00:09:40.399 --> 00:09:43.759
you to give an oral testimony, and they may also
151
00:09:43.879 --> 00:09:48.080
ask you to bring documents, and it'll have the lawyer's
152
00:09:48.200 --> 00:09:51.120
name on it, both for the plaintiff and the defense,
153
00:09:51.840 --> 00:09:54.279
so you know that this is coming from the other
154
00:09:54.399 --> 00:09:57.519
side and not from the patient's attorney. You can always
155
00:09:57.519 --> 00:10:00.600
email them and ask them to come and sate you
156
00:10:00.679 --> 00:10:04.279
for your time. Again, it's hard because they are not
157
00:10:04.759 --> 00:10:08.720
legally required to pay you the defense side, but a
158
00:10:08.720 --> 00:10:11.039
lot of the times they'll say, sure, doctor, how much
159
00:10:11.080 --> 00:10:14.039
do you charge, and they'll negotiate with you and then
160
00:10:13.679 --> 00:10:15.919
you can You can reach an agreement, but you have
161
00:10:15.960 --> 00:10:19.039
to do a little bit of persistence confidence and tell
162
00:10:19.039 --> 00:10:22.279
them you're busy, because we are busy. Again, settlement can
163
00:10:22.320 --> 00:10:24.720
reach at any stage, So they may set a date
164
00:10:24.759 --> 00:10:28.039
for you to do your deposition, but they can settle
165
00:10:28.080 --> 00:10:31.840
before that. They can settle right after your deposition. You
166
00:10:31.919 --> 00:10:33.519
never know when the case is going to get settled.
167
00:10:33.519 --> 00:10:38.919
Sometimes even before the jury, right after closing arguments, a
168
00:10:38.960 --> 00:10:42.600
case can settle. So settlements can happen at any stage,
169
00:10:42.639 --> 00:10:45.320
So just be mindful of that. Just because you're you
170
00:10:45.399 --> 00:10:48.159
have a trial date and you take time off of
171
00:10:48.240 --> 00:10:50.399
work and all of that, and you may even show
172
00:10:50.440 --> 00:10:52.919
up to the court and they settle that morning. So
173
00:10:53.200 --> 00:10:56.759
I always tell my chiropractor buddies, like, if you're going
174
00:10:56.840 --> 00:11:00.720
to go to court and you're taking time off, you
175
00:11:00.919 --> 00:11:05.240
have to ask for your money for your time, even
176
00:11:05.279 --> 00:11:08.320
if they settle. So that's something that you have to
177
00:11:08.360 --> 00:11:11.120
negotiate with the plaintiff side. Of course, the defense is
178
00:11:11.159 --> 00:11:13.480
not going to negotiate with you. They don't legally have to.
179
00:11:13.799 --> 00:11:16.279
But most of the time your plane off attorneys will say, sure,
180
00:11:16.360 --> 00:11:20.519
we understand things happen, So communicate with them in writing
181
00:11:21.080 --> 00:11:23.399
and make sure that you're compensated because this is not
182
00:11:23.559 --> 00:11:27.279
part of your lob. This is extra and know your worth.
183
00:11:27.919 --> 00:11:32.559
All right, let's move on to tort law basics negligence.
184
00:11:33.039 --> 00:11:35.919
You will not hear these terms in practice, but it's
185
00:11:35.919 --> 00:11:40.000
good to understand what's going on. So when a driver
186
00:11:40.240 --> 00:11:44.279
messes up and causes an accident, you can bring a
187
00:11:44.360 --> 00:11:49.000
lawsuit against that driver and bring that insurance company into
188
00:11:49.080 --> 00:11:53.200
that case with the vehicle of negligence. That is the
189
00:11:53.320 --> 00:11:56.679
legal cause of action. And in order to prove negligence,
190
00:11:57.279 --> 00:12:03.960
a planiff attorney has to prove four things. Duty, breach, causation,
191
00:12:04.360 --> 00:12:09.000
and damages. Duty and breach is something that the lawyers
192
00:12:09.039 --> 00:12:10.600
have to worry about. So I'm not going to get
193
00:12:10.600 --> 00:12:14.360
into that, but just to explain you, duty would be
194
00:12:14.960 --> 00:12:19.360
it's my duty to be careful when I'm driving, and
195
00:12:19.600 --> 00:12:23.879
I breach that duty if I don't follow the rules,
196
00:12:24.039 --> 00:12:28.519
the traffic rules. So that's how they bring those elements
197
00:12:28.600 --> 00:12:32.480
and evidence for those elements in courtrooms where you and
198
00:12:32.559 --> 00:12:36.799
I are going to get challenged as chiropractors is causation
199
00:12:36.960 --> 00:12:40.480
and damages. So the other two buckets, causation and damages.
200
00:12:40.559 --> 00:12:44.000
That's where majority of our testimony will come into play.
201
00:12:45.320 --> 00:12:53.440
Causation is the number one battleground every defense attorney will
202
00:12:53.480 --> 00:12:56.399
target you and your notes when it comes to causation.
203
00:12:56.559 --> 00:12:59.639
They want to make it sound like the accident did
204
00:12:59.759 --> 00:13:04.399
not cause this injury. Every case they'll say it's pre existing,
205
00:13:04.919 --> 00:13:08.320
it didn't happen from the accident. That were exaggerating, or
206
00:13:08.399 --> 00:13:11.200
the client or the patient is exaggerating. That's what the
207
00:13:11.200 --> 00:13:14.240
defense will say every single time. It's a given. So
208
00:13:14.360 --> 00:13:18.360
causation is a battleground. You will use your notes to
209
00:13:18.759 --> 00:13:21.679
link causation. They will use your notes to make it
210
00:13:21.759 --> 00:13:26.080
sound like causation is poor or there's no documentation for causation.
211
00:13:26.200 --> 00:13:30.080
So remember causation very important. A lot of the chiropractors
212
00:13:30.159 --> 00:13:35.159
don't document causation at all, and we'll get into that later.
213
00:13:35.720 --> 00:13:39.960
Damages again, not battleground for sure, but not that difficult
214
00:13:40.000 --> 00:13:42.320
to prove. This is where your bills come into place.
215
00:13:42.360 --> 00:13:46.559
When they say bills and records, the records goes towards causation.
216
00:13:47.600 --> 00:13:51.720
The bills are now used to prove damages, and not
217
00:13:51.799 --> 00:13:55.720
only just your bills, but entire whatever the patient did,
218
00:13:55.759 --> 00:14:00.600
whether any er record, any medical doctor, any anybody that
219
00:14:00.639 --> 00:14:06.360
they've seen. All that becomes past medical damages. Then there
220
00:14:06.399 --> 00:14:10.039
are other types of damages that the plaintiff can bring
221
00:14:10.639 --> 00:14:14.559
future there's past medical and there's future medical. This is
222
00:14:14.559 --> 00:14:18.320
when somebody is severely injured that they're going to need
223
00:14:19.639 --> 00:14:23.159
maybe twenty four to seven nursing facility things like that.
224
00:14:23.200 --> 00:14:25.679
I'm just giving you examples, but there's also what's going
225
00:14:25.720 --> 00:14:28.679
to happen in the future. So past medical are your bills.
226
00:14:28.720 --> 00:14:33.600
Future medical is speculative in so many ways, but a
227
00:14:33.679 --> 00:14:38.080
clever attorney will try to make that evidence come in
228
00:14:38.759 --> 00:14:43.600
and get compensation for what will happen in the future.
229
00:14:44.360 --> 00:14:48.039
There's other types of non economic economic damages, which again
230
00:14:48.080 --> 00:14:51.799
you don't need to know from your perspective, but it's
231
00:14:51.840 --> 00:14:56.440
always good to know overall what happens in any negligence case.
232
00:14:58.000 --> 00:15:03.480
So let's talk about causation. Clinical causation is very different
233
00:15:03.480 --> 00:15:07.320
from legal causation. So when what we study in school
234
00:15:07.679 --> 00:15:12.679
about causation, if somebody has ridiculopathy, then you're thinking okay,
235
00:15:12.720 --> 00:15:15.679
and maybe a disc injury there, so that is your
236
00:15:16.159 --> 00:15:24.679
clinical causation. Legal causation is proving that whatever injury or
237
00:15:24.720 --> 00:15:30.120
symptoms this patient is presenting with is directly link to
238
00:15:30.320 --> 00:15:36.480
this particular accident. And it's easier said than done because
239
00:15:36.600 --> 00:15:39.720
clever defense attorney is well, like I said, they have AMMO,
240
00:15:39.799 --> 00:15:42.840
they will use everything in your notes, any kind of
241
00:15:42.960 --> 00:15:47.559
past medical history to say this is pre existing, all
242
00:15:47.600 --> 00:15:51.159
sorts of stuff. So what can we do to make
243
00:15:51.440 --> 00:15:58.960
our documentation better? You have to link the injuries to
244
00:15:59.159 --> 00:16:03.360
the accident. So if somebody got into an accident yesterday
245
00:16:03.440 --> 00:16:06.840
and they presented with neck pain, don't just say they
246
00:16:06.840 --> 00:16:09.679
got into an accident and they came with neck pain today,
247
00:16:10.799 --> 00:16:14.200
because you see there is this missing piece of evidence there.
248
00:16:14.200 --> 00:16:15.960
You have to say they got into an accident on
249
00:16:16.000 --> 00:16:20.279
this particular date and because of that accident they are
250
00:16:20.320 --> 00:16:25.559
presenting with pain today. So just simple word connecting those
251
00:16:25.600 --> 00:16:29.600
two sentences now helps your notes look better. As far
252
00:16:29.639 --> 00:16:32.720
as causation is concerned, that is because of this accident,
253
00:16:33.000 --> 00:16:37.200
the patient is presenting with this symptoms. So causing, like
254
00:16:37.320 --> 00:16:41.360
the causation aspect, very very important. Document. Make sure you
255
00:16:41.440 --> 00:16:44.399
document mechanism of injury. A lot of us don't do that.
256
00:16:45.240 --> 00:16:49.360
We just say patient presents with neck pain. Mechanism of
257
00:16:49.399 --> 00:16:53.480
injury because of car accident. Also, if there's any extremities
258
00:16:53.519 --> 00:16:57.960
involved for a regular spine injury neck and back, it's
259
00:16:58.200 --> 00:17:00.600
sort of implied at this point that if somebody has
260
00:17:00.679 --> 00:17:05.839
a car accident injury, whiplash injury, that it's neck and back.
261
00:17:05.920 --> 00:17:09.519
So we don't have to worry too much about explaining
262
00:17:09.599 --> 00:17:12.240
neck and back pain. But if they have knee pain,
263
00:17:12.400 --> 00:17:16.359
shoulder pain, ankle pain, you have to go a step
264
00:17:16.400 --> 00:17:21.079
forward and document that why. So always good practice to
265
00:17:21.160 --> 00:17:24.839
ask your patients did you hit your knee to the
266
00:17:24.920 --> 00:17:29.079
dashboard or if they present with wrist pain, explain where
267
00:17:29.200 --> 00:17:31.720
was your arm or your hand was it on the
268
00:17:31.759 --> 00:17:35.799
steering wheel? What happened? Get that information from the patient
269
00:17:36.039 --> 00:17:39.079
and document it. If they give you that information, do it.
270
00:17:39.119 --> 00:17:43.240
If they say, oh, I don't remember, but it hurts,
271
00:17:43.720 --> 00:17:46.839
then you can always document that don't remember exactly what happened,
272
00:17:46.839 --> 00:17:50.000
the accident happened too fast, but did not have any
273
00:17:50.039 --> 00:17:54.279
pain before the accident, but now after the accident, they
274
00:17:54.279 --> 00:17:57.640
said that their risk is hurting, and so that helps.
275
00:17:58.359 --> 00:18:06.079
Be truthful, but be persuasive when you're writing now timing
276
00:18:06.119 --> 00:18:10.279
of symptom manifestation again link directly towards causation. It's important
277
00:18:10.319 --> 00:18:12.920
that most of the time it depends on the case.
278
00:18:12.960 --> 00:18:16.599
If you have a case that the accident happened recently
279
00:18:16.759 --> 00:18:20.480
and you saw them two or three weeks within that timeframe.
280
00:18:21.000 --> 00:18:24.079
It's implied the timing is easy. That's a good, good story.
281
00:18:24.119 --> 00:18:28.200
But you will get cases in practice that accident happened
282
00:18:28.240 --> 00:18:31.400
six months ago and they're having pain right now. There's
283
00:18:31.440 --> 00:18:33.400
not much you can do about that as far as
284
00:18:33.519 --> 00:18:37.200
documenting causation. But you can say, ask the patient, what
285
00:18:37.319 --> 00:18:40.920
did you do for this gap that six months? Did
286
00:18:40.960 --> 00:18:44.400
you treat at home? What happened? Why were you not
287
00:18:44.480 --> 00:18:47.880
able to get treatment sooner? And then they'll tell you, oh,
288
00:18:47.880 --> 00:18:50.240
I didn't have transportation, I didn't have that. It's okay
289
00:18:50.240 --> 00:18:53.640
to document that. Like I said, be truthful. But these
290
00:18:53.680 --> 00:18:56.440
are the questions that you can ask your patient, and
291
00:18:56.480 --> 00:19:01.039
it'll make you not a regular chiropractor, but a well
292
00:19:01.079 --> 00:19:07.720
informed chiropractor who understands how to alleviate or increase the
293
00:19:07.799 --> 00:19:10.519
value of their notes. And so what you ask in
294
00:19:10.559 --> 00:19:13.799
your history matters. It's not a cookie cutter. Let me
295
00:19:13.880 --> 00:19:16.960
just ask all this accident questionnaire. No, no, no, think
296
00:19:17.799 --> 00:19:20.200
look at the date of the accident. See if there
297
00:19:20.240 --> 00:19:22.920
is gaps, try and see if you get information out
298
00:19:22.960 --> 00:19:25.799
of them to kind of connect causation there. It'll make
299
00:19:25.839 --> 00:19:31.559
your notes more valuable. Acute versus chronic symptoms.
300
00:19:30.880 --> 00:19:31.200
This is.
301
00:19:32.920 --> 00:19:36.480
So common. Every defense attorney will say, this is not
302
00:19:36.599 --> 00:19:39.160
a cute, this is chronic. That's where you're orthopedic testing
303
00:19:39.240 --> 00:19:44.160
your palpatient skills. Everything will come into play here. Your doctors,
304
00:19:44.200 --> 00:19:48.000
you know how to document acute versus chronic. But also
305
00:19:48.119 --> 00:19:52.279
know that in real life, we get our plaintiffs the
306
00:19:52.279 --> 00:19:55.079
way we get them, meaning every patient will have pre
307
00:19:55.200 --> 00:19:59.920
existing conditions and it's okay. It's fine if they have
308
00:20:00.079 --> 00:20:02.599
car accidents in the past, it's okay to document that.
309
00:20:03.079 --> 00:20:07.119
But then you can also document sure they had accident previously,
310
00:20:07.160 --> 00:20:10.480
that there's a history of car accident, but they didn't
311
00:20:10.519 --> 00:20:14.000
have much pain before this accident, and this accident exacerbated
312
00:20:14.039 --> 00:20:18.200
their symptoms. So one sentence can now say, sure, my
313
00:20:18.359 --> 00:20:22.359
patient is sixty five years old and had some arthritic
314
00:20:22.440 --> 00:20:26.240
changes in the spine, but it's doing fine, and now
315
00:20:26.359 --> 00:20:30.240
after this wreck, and if they are feeling exacerbation of symptoms,
316
00:20:30.279 --> 00:20:34.160
and then say that document that. So connecting again to
317
00:20:34.839 --> 00:20:38.720
causation will help you make your notes stronger and that
318
00:20:39.039 --> 00:20:42.440
testimony is now backed up by your notes. History of
319
00:20:42.480 --> 00:20:46.799
past pain prior collisions very very important. There's no such
320
00:20:46.839 --> 00:20:49.319
thing as hiding a bad fact, like I said, a
321
00:20:49.359 --> 00:20:52.799
lot of our patients will have multiple carrects, or they're older,
322
00:20:52.920 --> 00:20:56.480
they've got other comorbidities and other issues going on. Defense
323
00:20:56.519 --> 00:20:59.200
will point at that, and it's fine let them. You
324
00:20:59.240 --> 00:21:02.279
can always say they had those issues, but this accident
325
00:21:03.039 --> 00:21:08.839
exacerbated their symptoms, which they did. And the next in
326
00:21:08.920 --> 00:21:15.079
line is that this particular phrase, reasonable medical probability, very
327
00:21:15.160 --> 00:21:19.160
very important phrase every time a defense attorney asks you
328
00:21:19.200 --> 00:21:23.680
in person or in trial or off the record, so doctor,
329
00:21:23.720 --> 00:21:27.519
are you sure? Are you sure that this injury is
330
00:21:27.640 --> 00:21:32.039
caused by this car wreck? Are you one hundred percent sure? Well,
331
00:21:32.119 --> 00:21:34.440
let me tell you, doctors, you don't have to be
332
00:21:34.480 --> 00:21:40.559
one hundred percent sure. The legal standard is reasonable medical probability,
333
00:21:41.400 --> 00:21:46.440
meaning more likely than not, meaning if you are about
334
00:21:47.240 --> 00:21:51.640
seventy percent sure that this type of symptoms will manifest
335
00:21:51.680 --> 00:21:55.480
after a car accident. You have everything that you need
336
00:21:55.559 --> 00:21:58.119
to give that statement. You don't have to be one
337
00:21:58.200 --> 00:22:01.720
hundred percent sure that all is injuries are because of
338
00:22:01.720 --> 00:22:05.440
this accident. You just have to be more likely than
339
00:22:05.480 --> 00:22:09.039
not sure. So the standard is reasonable medical probability, and
340
00:22:09.079 --> 00:22:12.079
that you can say that with confidence. No one can
341
00:22:12.119 --> 00:22:15.680
be one hundred percent sure, can you be sure enough, Yeah,
342
00:22:15.839 --> 00:22:22.279
I have reasonable medical probability that my patient symptoms stem
343
00:22:22.319 --> 00:22:28.240
from this particular injury. Let's continue with strong documentation. Mechanism
344
00:22:28.240 --> 00:22:31.559
of injury very important. Please document that, definitely document that.
345
00:22:31.559 --> 00:22:36.480
For extremities, do your regular range of motion testing, orthopedic testing.
346
00:22:36.599 --> 00:22:39.759
You can use outcome measures also vestry, and there's so
347
00:22:39.839 --> 00:22:42.599
many out there and the it's good to use those
348
00:22:42.640 --> 00:22:46.039
because you can use that as objective data, not just
349
00:22:46.079 --> 00:22:48.279
what patient is saying. But hey, look I did all
350
00:22:48.279 --> 00:22:51.519
this testing and proof. I have evidence to show that
351
00:22:51.559 --> 00:22:55.839
they were hurting and now after treatment they've gotten better.
352
00:22:56.160 --> 00:23:00.200
Progression things like that, you can use them. Functional limitation
353
00:23:00.599 --> 00:23:04.480
very very important. Don't just document pain, also document things
354
00:23:04.480 --> 00:23:07.960
that they are not able to do. From practice perspective,
355
00:23:08.000 --> 00:23:10.440
a lot of the times my patients are saying, oh
356
00:23:10.480 --> 00:23:13.640
the pain is same or they're not giving you much.
357
00:23:13.720 --> 00:23:15.519
But if you ask them or are you able to
358
00:23:15.519 --> 00:23:19.640
do your ADLs? Can you handle cooking, cleaning house stores?
359
00:23:19.799 --> 00:23:22.279
Are you able to drive like before? Can you go
360
00:23:22.319 --> 00:23:25.240
to the gym? Depending on patient's age and in their
361
00:23:25.279 --> 00:23:29.079
functional activity status before the accident, good questions to ask
362
00:23:29.240 --> 00:23:31.160
and these are the things that you can ask every
363
00:23:31.240 --> 00:23:33.920
time they come in and document it on your soap
364
00:23:33.960 --> 00:23:37.079
notes to saying functional limitations, things that are not able
365
00:23:37.119 --> 00:23:39.880
to do like they used to before the accident. Good
366
00:23:39.960 --> 00:23:44.799
good documentation. Progression of care. This is something that will
367
00:23:44.839 --> 00:23:49.680
help you when defense will try to make it sound
368
00:23:49.799 --> 00:23:54.400
like your care is redundant or not medically necessary or
369
00:23:54.519 --> 00:23:58.440
excessive when they say, well, doctor, did you really need
370
00:23:58.480 --> 00:24:04.240
to see this patient twenty something times? Yes? And why?
371
00:24:04.680 --> 00:24:08.160
Progression of care so you don't just say pain levels
372
00:24:08.200 --> 00:24:11.839
went down. Also say functional limitations that you documented early
373
00:24:12.279 --> 00:24:15.519
are now getting better. If they're getting better, also use
374
00:24:15.640 --> 00:24:19.480
your outcome measures, do it again, re examine things like
375
00:24:19.519 --> 00:24:23.240
that to show medical necessity. This is how you build
376
00:24:23.400 --> 00:24:27.880
strong documentation to kind of justify the number of treatments
377
00:24:27.920 --> 00:24:34.359
that you're giving this particular patient. Updated diagnosis. I have
378
00:24:34.559 --> 00:24:38.759
seen so many chiropractors. I don't know if this is
379
00:24:38.880 --> 00:24:42.599
lazy conduct or I don't know why, but a lot
380
00:24:42.640 --> 00:24:45.839
of chiropractors stop doing re examination and they're not updating
381
00:24:45.839 --> 00:24:50.240
diagnosis once they get the imaging results back. So we
382
00:24:50.319 --> 00:24:53.880
send out for let's say MRI. You're suspecting that there
383
00:24:53.960 --> 00:24:57.279
is a bulging disc her needed disc Now you have
384
00:24:58.039 --> 00:25:01.000
confirmation on the MRI that they do, you go back
385
00:25:01.039 --> 00:25:05.319
and change your diagnosis. Added, it's important to update diagnosis
386
00:25:05.359 --> 00:25:09.400
that shows that this is not just a regular cookie
387
00:25:09.400 --> 00:25:12.200
cutter case that everybody has the same Diagno. No, I
388
00:25:12.279 --> 00:25:17.920
am changing my treatment plan based off of whatever imaging
389
00:25:17.960 --> 00:25:22.559
I'm getting, and I'm also updating diagnosis. And so your
390
00:25:22.640 --> 00:25:26.319
initial diagnosis is there, but then you kind of refine
391
00:25:26.359 --> 00:25:30.160
it depending on what happens next, depending on the imaging finding.
392
00:25:30.200 --> 00:25:33.279
So if somebody may have a specific right now, maybe
393
00:25:33.279 --> 00:25:37.400
you just documented sprain strain at the shoulder, but now
394
00:25:37.480 --> 00:25:42.680
you know exactly which muscle, then be more specific. It's
395
00:25:42.720 --> 00:25:44.960
hard to do in practice. Trust me, I've been doing
396
00:25:45.000 --> 00:25:46.920
this for eight years. I see a lot of new
397
00:25:46.920 --> 00:25:48.759
patients a month and it's just, oh, I have to
398
00:25:48.799 --> 00:25:51.720
do this again. But you have to because it's good
399
00:25:51.920 --> 00:25:55.519
and it also gives you strong notes to defend, and
400
00:25:55.559 --> 00:25:58.480
then you can alter your treatment plan based off of
401
00:25:58.680 --> 00:26:01.440
what's going on. You can docum in that Okay, I
402
00:26:01.519 --> 00:26:04.160
suspected that there was sprain strain on the shoulder, but
403
00:26:04.240 --> 00:26:07.880
now I know that there is I don't know super
404
00:26:07.880 --> 00:26:11.039
spinnatus tair. So we've added this kind of exercises to
405
00:26:11.160 --> 00:26:14.279
rehab that, and so that adds value to your notes
406
00:26:14.839 --> 00:26:21.079
and consistency. Again, because of the EHRs WUS Cairo touch
407
00:26:21.160 --> 00:26:25.079
or there's so many out there, there can be inconsistency,
408
00:26:25.599 --> 00:26:28.319
so be mindful of that. Like let's say you forgot
409
00:26:28.319 --> 00:26:31.880
to add the soap and you went back and you
410
00:26:31.920 --> 00:26:34.680
added it, and everything from the first two visits kind
411
00:26:34.720 --> 00:26:38.440
of rolled back into this one. So your visit fifteen
412
00:26:38.799 --> 00:26:42.559
has the same level of pains as visit second, and
413
00:26:42.680 --> 00:26:45.519
on the sixteenth again it dropped down to like nothing.
414
00:26:45.680 --> 00:26:48.960
So be careful. You're very busy, and there may be
415
00:26:49.079 --> 00:26:51.519
sometimes your staff is doing the soaps for you. So
416
00:26:52.119 --> 00:26:54.400
you as the doctor, you're the one who's responsible for
417
00:26:54.440 --> 00:26:56.440
your notes. You're the one who's signing it, so it
418
00:26:56.519 --> 00:26:59.920
has to sound consistent. Make sure if there are gaps
419
00:27:00.160 --> 00:27:04.720
treatment that you document that in things like that, common
420
00:27:04.759 --> 00:27:09.839
documentation mistakes, copy paste notes. This happens a lot in practice.
421
00:27:10.160 --> 00:27:13.480
And when you'll find people that are in the same crash,
422
00:27:13.920 --> 00:27:16.839
like four people in the same car crash, right, and
423
00:27:17.559 --> 00:27:21.640
all four of them have the same identical diagnosis list.
424
00:27:22.279 --> 00:27:27.680
They have same muscular skeletal findings, and some things are
425
00:27:27.720 --> 00:27:31.440
going to be the same. If you treat athletes and
426
00:27:31.519 --> 00:27:34.519
you're treating concussion, a lot of the documentation is going
427
00:27:34.559 --> 00:27:37.160
to be the same. So that's my argument always like, hey,
428
00:27:37.200 --> 00:27:40.200
I'm a chiropractor, I see muscular skelet injuries, I treat
429
00:27:40.240 --> 00:27:43.000
car accident patients. A lot of these things are going
430
00:27:43.039 --> 00:27:45.480
to be the same. My choice of orthopedic testing are
431
00:27:45.519 --> 00:27:48.559
going to be the same. But there has to be
432
00:27:48.640 --> 00:27:51.440
some things that are different, right, because every human being
433
00:27:51.519 --> 00:27:55.480
is different. So that is your job to be the
434
00:27:55.519 --> 00:27:58.400
best doctor that you are. Use all the training that
435
00:27:58.440 --> 00:28:03.200
you're chiropractical school taught you, and in document things that
436
00:28:03.240 --> 00:28:06.519
are different. Don't be copy pasting notes. Try to find
437
00:28:07.119 --> 00:28:10.920
individualistic finding. It can be very simple like pel patient
438
00:28:11.000 --> 00:28:15.920
finding something that is unique to that particular patient. That's
439
00:28:16.000 --> 00:28:20.039
one way to negate the allegation of copy paste notes.
440
00:28:20.720 --> 00:28:24.480
Gaps in care very very important. This is where defense
441
00:28:24.519 --> 00:28:28.359
will come in and say your patient is not hurting,
442
00:28:28.839 --> 00:28:31.640
Your client is not hurting, they are not coming in,
443
00:28:32.200 --> 00:28:34.359
or you have not seen them in three months. You
444
00:28:34.440 --> 00:28:37.400
never did it re exam. So gaps in care is
445
00:28:37.480 --> 00:28:40.599
always a problem. We can't control this. You can't force
446
00:28:40.640 --> 00:28:44.240
your patient to come in. You can recommend them. That's
447
00:28:44.279 --> 00:28:46.000
the best you can do. So do your best to
448
00:28:46.240 --> 00:28:50.839
document gaps in care. Ask them what happened, didn't have transportation, rated,
449
00:28:51.559 --> 00:28:55.039
was traveling? Was sick this that the other. If they
450
00:28:55.039 --> 00:28:57.799
give you answers, document and do your best. If they
451
00:28:57.799 --> 00:29:00.160
don't give you answers, there's nothing you can do. It's
452
00:29:00.200 --> 00:29:03.119
not much you can control in this area. But educating
453
00:29:03.200 --> 00:29:07.640
your patient is important. Definitely communicate with them, have your
454
00:29:07.640 --> 00:29:11.440
staff communicate with them. Let them know gaps is bad,
455
00:29:11.519 --> 00:29:15.920
bad bad. And if there's a really humongous gap, like
456
00:29:16.000 --> 00:29:20.559
re exam, please please do a re exam. Inconsistency We
457
00:29:20.640 --> 00:29:25.559
talked about that already. Over and undertreatment another way. Defense
458
00:29:25.599 --> 00:29:29.200
will like to target our notes. They'll always say they'll
459
00:29:29.240 --> 00:29:33.079
always say you treat them way too many times, and
460
00:29:33.559 --> 00:29:36.480
lately they're saying undertreatment, which is a new one that
461
00:29:36.519 --> 00:29:39.240
I'm seeing. So yeah, they will always attack you on that.
462
00:29:40.279 --> 00:29:43.480
Be confident in responding to these answers. If you documented
463
00:29:43.559 --> 00:29:46.960
that many visits, you documented that many wizards, it's industry standard.
464
00:29:47.440 --> 00:29:51.319
Stick with it. Be confident when you answer these questions.
465
00:29:51.359 --> 00:29:54.559
If you yourself seem defeated when answering those questions and
466
00:29:54.599 --> 00:29:57.200
you feel like, I don't think if you're not confident
467
00:29:57.200 --> 00:29:59.000
in your own notes, like, how are you going to
468
00:29:59.000 --> 00:30:03.160
convince a jury, let alone a defense attorney. So make
469
00:30:03.240 --> 00:30:06.519
sure that if you set a treatment plan that you
470
00:30:06.519 --> 00:30:10.039
are one hundred percent by it. I don't want to
471
00:30:10.079 --> 00:30:12.440
say what number is, Okay, one number is not. It
472
00:30:12.480 --> 00:30:17.680
really depends on the patient. We are. We're very patient
473
00:30:17.799 --> 00:30:20.759
centric and we make the decision based on the client,
474
00:30:20.799 --> 00:30:24.559
on the patient, not like this scale of this number
475
00:30:24.599 --> 00:30:27.119
of sessions for every patient. Now it's just patient dependent
476
00:30:27.559 --> 00:30:30.960
and it depends on many, many, many, many factors. Comorbidities
477
00:30:31.039 --> 00:30:34.319
and age of the patient, how active they are, the
478
00:30:34.680 --> 00:30:38.440
severity of their injuries, things like that. Okay, last, but
479
00:30:38.519 --> 00:30:42.359
not the least. Please please, Caidropractice, if you take one thing,
480
00:30:43.160 --> 00:30:48.839
one thing from this webinar, do not do not document
481
00:30:50.039 --> 00:30:54.200
attorney driven care. What do I mean by that? I
482
00:30:54.279 --> 00:31:00.000
have seen notes where Caidropractice are written attorney denied, MRIs,
483
00:31:00.759 --> 00:31:08.400
attorney approved, MRI, attorney did not approve additional treatments. Please
484
00:31:08.480 --> 00:31:10.960
don't document that. It's common sense, but people do it
485
00:31:11.000 --> 00:31:14.400
all the time. I understand what you're trying to communicate there.
486
00:31:14.519 --> 00:31:16.920
Maybe there is some way, you're trying to document that
487
00:31:17.000 --> 00:31:21.359
I did my due diligence. I think the patient needs MRI,
488
00:31:21.599 --> 00:31:24.960
but the attorney denied it. When you document things like that,
489
00:31:25.200 --> 00:31:28.480
you're saying that it's attorney driven medical care, and that's
490
00:31:28.519 --> 00:31:31.039
going to be a big no no. It's a major
491
00:31:31.079 --> 00:31:34.440
red flag, not only for that case that you're asked
492
00:31:34.480 --> 00:31:38.799
to give a deposition for, but overall, for overall ethics.
493
00:31:39.279 --> 00:31:42.480
We can't have attorneys practice medicine. We can't have attorney's
494
00:31:42.559 --> 00:31:47.039
practice chiropractic care. It's your call, So please refrain from
495
00:31:47.039 --> 00:31:51.039
documenting that. Even internally, a lot of these internal notes
496
00:31:51.079 --> 00:31:55.839
are now being discoverable, So be very careful if imagine
497
00:31:55.839 --> 00:31:58.240
that these documents are being read in court and you
498
00:31:58.440 --> 00:32:00.480
not want to write something that you can get in
499
00:32:00.559 --> 00:32:06.680
trouble with. Let's talk about affidavits and subpoenas. So subpoenas,
500
00:32:06.720 --> 00:32:09.200
like we already discuss, you can get subpoena by the
501
00:32:09.200 --> 00:32:12.880
defense attorney to come and give a deposition. Besides that,
502
00:32:13.039 --> 00:32:16.559
you can also have subpoenas for documents, records. Trival companies,
503
00:32:16.599 --> 00:32:20.000
third party companies will give you those subpoenas, and they
504
00:32:20.000 --> 00:32:24.119
can be really broad if they are asking for information
505
00:32:24.279 --> 00:32:29.079
such as your internal notes or your communication with the
506
00:32:29.119 --> 00:32:34.240
plaintiff attorneys. That's too broad of a skull and they
507
00:32:34.279 --> 00:32:37.279
should not be asking, but they will, so I recommend
508
00:32:37.279 --> 00:32:39.839
that if you feel like they're fishing for information, reach
509
00:32:39.839 --> 00:32:41.799
out to the planeff attorneys. Sometimes you may have to
510
00:32:41.799 --> 00:32:45.480
get your own lawyer to quash those because that's not right.
511
00:32:46.200 --> 00:32:49.680
But they'll try their best, and it's annoying, but we
512
00:32:49.759 --> 00:32:52.200
all have to deal with that. You can charge them
513
00:32:52.680 --> 00:32:57.839
for providing them with records reasonable fee, and they're not
514
00:32:57.880 --> 00:33:03.000
your friends, so it's okay to buy time and make
515
00:33:03.039 --> 00:33:05.960
it difficult for them. Sometimes I ask them I will
516
00:33:05.960 --> 00:33:09.160
release it once your check is cleared to make sure
517
00:33:09.200 --> 00:33:11.720
I'm getting paid for it. But yep, you will see
518
00:33:11.720 --> 00:33:14.519
that a lot in practice, so be careful. You don't
519
00:33:14.559 --> 00:33:17.920
have to worry about doing them yourselves, especially the written
520
00:33:18.000 --> 00:33:20.759
questions that yes and no, the dwqs. Your staff can
521
00:33:20.799 --> 00:33:23.359
do them. Your staff can sign them, but at the
522
00:33:23.440 --> 00:33:25.319
end of the day, your license on the line, so
523
00:33:25.480 --> 00:33:28.480
I always review it. If it's standard, they'll know what
524
00:33:28.559 --> 00:33:32.039
to do. But if they're asking for very detailed, complicated language,
525
00:33:32.680 --> 00:33:36.960
look it up. Hire a lawyer if you need to depositions,
526
00:33:37.000 --> 00:33:40.680
we have to do another seminar, but yeah, depositions basically
527
00:33:41.119 --> 00:33:44.480
plain if attorney or defense attorney asking you questions, it's
528
00:33:44.640 --> 00:33:49.759
testimony under oath. It can be online what in person.
529
00:33:49.960 --> 00:33:52.400
Back in those days, they used to come into your
530
00:33:52.400 --> 00:33:54.400
office and do it. Now most of these are done
531
00:33:54.440 --> 00:33:57.039
on zoom, but they can still come in office and
532
00:33:57.079 --> 00:34:00.000
do it. It's not done in the court. It's testimony
533
00:34:00.119 --> 00:34:04.400
outside the court. But because it's it's basically testimony that
534
00:34:04.440 --> 00:34:06.519
can be used in court. So if you're not going
535
00:34:06.559 --> 00:34:09.119
to be available to give your life testimony in court,
536
00:34:09.400 --> 00:34:12.639
a lot of the times it's recorded in a deposition setting,
537
00:34:12.760 --> 00:34:15.599
and that way they can use that instead of you
538
00:34:15.719 --> 00:34:18.920
going to court. The court reborder's presence, so everything that
539
00:34:19.000 --> 00:34:22.800
you say is going to be transcribed, and every time
540
00:34:22.800 --> 00:34:26.440
you say and and all of that also gets documented.
541
00:34:26.519 --> 00:34:29.960
So sometimes when you read it, like ah, it sounds cringe,
542
00:34:30.000 --> 00:34:33.119
but it's the nature of the game, and so it's
543
00:34:33.159 --> 00:34:37.000
important that you prepare for deposition. It can be really long,
544
00:34:37.559 --> 00:34:41.840
anywhere between two to six hours depending on the case,
545
00:34:42.360 --> 00:34:44.639
and it can be used for more than one case.
546
00:34:44.679 --> 00:34:47.320
Doctors don't really pay attention to that, but it is true,
547
00:34:47.480 --> 00:34:49.679
a deposition that you may have given two years ago
548
00:34:49.800 --> 00:34:54.679
for this particular attorney can be used for a case
549
00:34:54.679 --> 00:34:57.159
that's coming up three years from now, or if they're
550
00:34:57.199 --> 00:35:00.800
trying to find or come after you, they can use that.
551
00:35:00.920 --> 00:35:04.960
So that's deposition. We have to do another webinar for that.
552
00:35:05.159 --> 00:35:08.480
But you can always use your own lawyer if you're
553
00:35:08.519 --> 00:35:13.000
really intimidated or you feel like they're trying for you
554
00:35:13.079 --> 00:35:15.880
to give statements that has nothing to do with the
555
00:35:15.920 --> 00:35:18.840
case that you're being called to do a deposition for.
556
00:35:19.159 --> 00:35:22.239
So it's this person'suing this person. You are a fact witness,
557
00:35:22.639 --> 00:35:25.519
but they're asking you all the questions pertaining to where
558
00:35:25.559 --> 00:35:29.440
you're working and other stuff has nothing to do with that,
559
00:35:29.639 --> 00:35:33.440
and you're suspecting some kind of weird things happening. Yeah,
560
00:35:33.599 --> 00:35:35.960
just call an attorney have them come in. There's so
561
00:35:36.079 --> 00:35:38.360
much more that lawyers can do to protect you in
562
00:35:38.360 --> 00:35:41.559
a deposition settings, but majority of the times is related
563
00:35:41.559 --> 00:35:44.039
to the case. You can charge them a reasonable fee
564
00:35:44.320 --> 00:35:47.039
and you can give you a testimony and be confident
565
00:35:47.039 --> 00:35:50.599
in giving the testimony. Defense will try to attack your
566
00:35:50.599 --> 00:35:53.400
credibility and deposition. Main thing they'll try to say, you
567
00:35:53.440 --> 00:35:57.280
don't know what you're talking about that it's all attorney
568
00:35:57.360 --> 00:36:01.639
driven treatment. Everything is overtreatment for them. They'll say the
569
00:36:01.679 --> 00:36:06.599
treatments are not medically necessary. They'll say, or MRIs if
570
00:36:06.599 --> 00:36:10.320
we're not necessary, that you have a financial gain or
571
00:36:10.400 --> 00:36:15.119
incentive for sending them out for imaging testing. They'll attack
572
00:36:15.159 --> 00:36:17.920
you in a scope of practice. These are for dcs
573
00:36:17.960 --> 00:36:20.679
that have a DC and P setting that they are
574
00:36:20.719 --> 00:36:24.039
doing not only chiropractic care, but also a little bit
575
00:36:24.079 --> 00:36:26.519
of medical in there, so they'll try to attack you
576
00:36:26.559 --> 00:36:31.559
on those. They'll find documentation gaps, and then long story short,
577
00:36:31.719 --> 00:36:34.119
the goal for deposition is to make you look like
578
00:36:35.480 --> 00:36:38.360
you're not smart enough or you're lying in front of
579
00:36:38.360 --> 00:36:41.440
the jury and our jury, depending on the jurisdiction that
580
00:36:41.480 --> 00:36:46.159
you're from, sometimes there's a jury bias. Still people think
581
00:36:46.199 --> 00:36:50.159
that chiropractic care is not as credible as medical care.
582
00:36:50.360 --> 00:36:53.840
That they think that we're not perfect doctors or good
583
00:36:53.880 --> 00:36:57.360
doctors or real doctors, and so they will try to
584
00:36:57.400 --> 00:36:59.920
attack you on the jury bias. So what do you do?
585
00:37:00.079 --> 00:37:04.719
You talk about your amazing education that your school gave you,
586
00:37:04.840 --> 00:37:08.639
all the science classes that you've taken, and that you've
587
00:37:08.679 --> 00:37:11.280
been doing this with this many years and when you
588
00:37:11.320 --> 00:37:14.480
start talking and you're using just the right amount of
589
00:37:14.760 --> 00:37:19.519
medical knowledge with plain language that somebody else will understand,
590
00:37:19.760 --> 00:37:22.760
then this goes away so very quickly, the jewry bias
591
00:37:22.840 --> 00:37:26.079
goes away as they start listening to you. You have
592
00:37:26.119 --> 00:37:30.039
to sound smart and confident, because guys, understand this. You're
593
00:37:30.079 --> 00:37:32.760
not giving a testimony to your professors. You're giving a
594
00:37:32.760 --> 00:37:39.039
testimony to a juror that whose education level is probably
595
00:37:39.079 --> 00:37:42.079
no more than ninth grade education, and that's what they
596
00:37:42.079 --> 00:37:43.599
did us in law school. So you have to use
597
00:37:43.599 --> 00:37:48.320
simple language and not sound arrogant, but also at the
598
00:37:48.360 --> 00:37:53.559
same time confident and explain them what chiropractors do and
599
00:37:53.599 --> 00:37:56.760
how we help this patient, and be confident. Whether that's
600
00:37:56.800 --> 00:38:01.119
deposition or life testimony. It's important that you believe in
601
00:38:01.159 --> 00:38:06.039
your treatment and you believe that you're in a profession
602
00:38:06.119 --> 00:38:08.960
to help people. And it radiates in the way you
603
00:38:09.000 --> 00:38:13.719
communicate how to have handled a position. Answer only what
604
00:38:13.880 --> 00:38:19.199
is asked. Please remember, defense counsel not your friend. Plaintiff
605
00:38:19.239 --> 00:38:23.159
counsel also not your friend. You are not here to
606
00:38:23.239 --> 00:38:25.840
build a case for them. You're just defending your notes.
607
00:38:25.880 --> 00:38:29.320
You're not really defending the client. That's the lawyer's job.
608
00:38:29.840 --> 00:38:33.639
Let the lawyer defend the patient. Let the lawyer make
609
00:38:33.920 --> 00:38:36.559
or break the case for the patient. Your job is
610
00:38:36.639 --> 00:38:40.039
to stay focused on your notes, so answer only what
611
00:38:40.199 --> 00:38:45.280
is asked, stay within your scupe. Plaintiff attorneys are notorious
612
00:38:45.719 --> 00:38:48.679
for asking you questions that are outside your scope. Your
613
00:38:48.719 --> 00:38:51.599
patients attorney will ask you, so, doctor, do you think
614
00:38:51.760 --> 00:38:55.800
the surgery was necessary? Or do you think the surgical
615
00:38:55.880 --> 00:39:01.119
bills are industry standard? Or they'll ask you about accident reconstruction,
616
00:39:01.760 --> 00:39:05.000
and it can get murky. Sometimes you have credentials to
617
00:39:05.039 --> 00:39:08.400
talk about it, depending on the person who's doing the
618
00:39:08.519 --> 00:39:11.519
depending on the doctor. Some doctors don't. And so it's
619
00:39:11.519 --> 00:39:15.119
okay to say that's not within my scope. It's fine
620
00:39:15.159 --> 00:39:17.360
even if that upsets them, that's okay. But stay within
621
00:39:17.400 --> 00:39:20.400
your scope. That will protect your license and your credibility.
622
00:39:20.639 --> 00:39:24.000
It's okay to say I don't know, please do not guess.
623
00:39:24.280 --> 00:39:27.880
That again, goes down to credibility. If you're honest, people
624
00:39:27.960 --> 00:39:31.159
can see that. Defend your notes, not the patient, very
625
00:39:31.239 --> 00:39:34.000
very important. Don't go out of your way in making
626
00:39:34.039 --> 00:39:36.519
a case for the patient. That is not your job.
627
00:39:36.599 --> 00:39:38.360
Let the lawyers do that. If they're a good lawyer.
628
00:39:38.400 --> 00:39:42.079
They can handle it. If there's a bad fact, it's okay.
629
00:39:42.320 --> 00:39:44.280
Let the lawyer be the lawyer. You're not the lawyer,
630
00:39:44.360 --> 00:39:48.440
you are the doctor. You are defending your notes. Please
631
00:39:48.480 --> 00:39:51.400
do not lie because that's perjury. You can use a
632
00:39:51.480 --> 00:39:54.719
license for that, So no lying. If you don't know
633
00:39:54.800 --> 00:39:57.000
it can always say I don't know. It's based off
634
00:39:57.039 --> 00:40:00.920
of your personal knowledge. If you don't have the person knowledge,
635
00:40:01.239 --> 00:40:03.880
don't answer it. Just say I don't know. It's okay
636
00:40:03.920 --> 00:40:08.239
to say that. Trial testimony looks very similar to deposition testimony,
637
00:40:08.239 --> 00:40:10.960
but it's high stakes. Why because it's live. In trial,
638
00:40:11.039 --> 00:40:13.719
there is a judge there. In depositions, you don't have
639
00:40:13.760 --> 00:40:16.599
a judge, so even if the other side objects, there
640
00:40:16.639 --> 00:40:19.320
is no life ruling on the objection, But in trial
641
00:40:19.400 --> 00:40:23.280
testimony there is. Which makes it easy for us as
642
00:40:23.639 --> 00:40:26.679
experts to give our testimony because it's short. They're not
643
00:40:26.760 --> 00:40:29.119
going to hold you in court for four or five hours.
644
00:40:29.119 --> 00:40:31.239
You may be waiting for your turn, but you're not
645
00:40:31.360 --> 00:40:34.440
giving a testimony for that long. It's pretty quick. It's fast,
646
00:40:34.920 --> 00:40:38.199
it's very jury focused. So simple language is the key.
647
00:40:38.320 --> 00:40:42.679
You have to sound confident but not arrogant to you
648
00:40:42.719 --> 00:40:45.760
don't have to be necessarily charming, but you don't also
649
00:40:45.840 --> 00:40:51.559
have to sound or somebody who's industry expert. Like you're
650
00:40:51.599 --> 00:40:54.840
not giving a testimony to your professors of your chiapractic school.
651
00:40:55.119 --> 00:40:58.639
You're talking to somebody that will believe everything that you're
652
00:40:58.679 --> 00:41:01.760
saying if you're saying it right. So make sure that
653
00:41:02.079 --> 00:41:05.719
you understand who your audience is. That adds value to
654
00:41:05.760 --> 00:41:08.920
your testimony. If I'm giving a testimony to my professor,
655
00:41:08.960 --> 00:41:12.320
I'm going to be scared because i have to justify everything.
656
00:41:12.400 --> 00:41:15.360
But when I'm answering it to my mom or I'm
657
00:41:15.400 --> 00:41:18.079
explaining why I'm to my patient, for example, why I'm
658
00:41:18.079 --> 00:41:20.119
explaining to my patient why you need to come in
659
00:41:20.119 --> 00:41:22.400
for this many number of visits, I'm able to do
660
00:41:22.440 --> 00:41:26.440
it more confidently. So always remember that your audience last,
661
00:41:26.440 --> 00:41:27.199
but not the least.
662
00:41:37.280 --> 00:41:40.679
That wraps up Part two of our conversation with doctor Panktyfidia.
663
00:41:41.320 --> 00:41:44.679
In this episode, we move beyond documentation and into the
664
00:41:44.679 --> 00:41:50.760
realities of subpoenas, records requests, depositions, trial testimony. We talked
665
00:41:50.800 --> 00:41:55.199
about expert witness, credibility and the ethical considerations that come
666
00:41:55.280 --> 00:41:59.440
with working in the PI or personal injury space. One
667
00:41:59.480 --> 00:42:02.840
of the biggest takeaways from this conversation is that chiropractors
668
00:42:02.920 --> 00:42:05.920
don't need to be afraid of the legal process, but
669
00:42:06.000 --> 00:42:10.400
they do need to be prepared. That means knowing your documentation,
670
00:42:10.559 --> 00:42:15.159
staying within your scope, answering only what is asked, avoiding speculation,
671
00:42:15.679 --> 00:42:18.639
and understanding that your job is not to defend the
672
00:42:18.679 --> 00:42:24.239
patient's entire case your job, your most important role, is
673
00:42:24.280 --> 00:42:28.679
to explain and support the care that you provided. Doctor
674
00:42:28.679 --> 00:42:32.760
Fidia also gave an important reminder that professional credibility starts
675
00:42:32.840 --> 00:42:37.920
long before a deposition or courtroom testimony. It starts in
676
00:42:37.960 --> 00:42:41.960
the exam room, in your clinical reasoning, in your documentation habits,
677
00:42:42.360 --> 00:42:44.800
and in the way you communicate your role as a
678
00:42:44.800 --> 00:42:50.079
healthcare provider. And perhaps most importantly, this episode is a
679
00:42:50.119 --> 00:42:53.960
reminder for healthcare providers to take pride in the value
680
00:42:54.000 --> 00:42:58.800
of conservative care when documented clearly and delivered ethically. The
681
00:42:58.840 --> 00:43:02.760
work that you do not only for the patient's recovery,
682
00:43:02.840 --> 00:43:06.519
but also for how that care is understood and represented
683
00:43:06.599 --> 00:43:10.679
when it becomes part of a larger legal process. A
684
00:43:10.760 --> 00:43:14.239
huge thank you to doctor Panktifidia for sharing her unique
685
00:43:14.239 --> 00:43:17.920
perspective as both a practicing chiropractor and a soon to
686
00:43:17.960 --> 00:43:21.320
be attorney and for helping providers better understand how to
687
00:43:21.400 --> 00:43:26.079
navigate this complex intersection of healthcare and law. As always,
688
00:43:26.199 --> 00:43:29.559
thanks for listening to the Factor podcast. Be sure to subscribe,
689
00:43:29.760 --> 00:43:32.920
follow or share this episode with a colleague or friend,
690
00:43:33.480 --> 00:43:37.000
and we will look forward to seeing you next time.
691
00:43:40.880 --> 00:43:42.840
Hey guys, if you like what you heard today, I
692
00:43:42.920 --> 00:43:46.480
encourage you to visit our website at Factor hyphenstore dot
693
00:43:46.480 --> 00:43:52.639
com that's spelled fa k tr hyphenstore dot com to
694
00:43:52.679 --> 00:43:55.239
find out more information about all that we have to offer.
695
00:43:55.440 --> 00:43:57.800
We have a variety of online offerings as well as
696
00:43:57.800 --> 00:44:01.199
our hands on Factor Rehab System Core scheduled in cities
697
00:44:01.239 --> 00:44:03.320
around the globe. Be sure to also check out our
698
00:44:03.320 --> 00:44:06.800
event calendar and bookmark any of these upcoming live webinar
699
00:44:06.880 --> 00:44:09.079
dates coming up in the near future so you can
700
00:44:09.159 --> 00:44:11.519
join us live. And of course, the biggest compliment we
701
00:44:11.559 --> 00:44:13.480
can receive is for you to help us spread the
702
00:44:13.519 --> 00:44:16.760
word to your friends, colleagues, and classmates. You'll find all
703
00:44:16.800 --> 00:44:19.360
the important links, as well as info about our sponsors
704
00:44:19.400 --> 00:44:21.519
in the show notes, so be sure to check those out.
1
00:00:01.520 --> 00:00:04.320
Welcome to the Factor Podcast, where we talk about the
2
00:00:04.360 --> 00:00:07.080
stuff they didn't teach you in school, how to grow
3
00:00:07.160 --> 00:00:10.359
your practice, refine your clinical skills, and get better results
4
00:00:10.400 --> 00:00:13.279
for your patients. We're here to help you navigate the
5
00:00:13.320 --> 00:00:16.920
real world challenges of being a healthcare provider, from delivering
6
00:00:17.000 --> 00:00:19.920
top notch patient care to running a business that doesn't
7
00:00:19.960 --> 00:00:22.719
run you into the ground. Whether you're fresh out of
8
00:00:22.719 --> 00:00:26.320
school or scaling your practice, we're diving into effective, cutting
9
00:00:26.440 --> 00:00:27.719
edge treatments.
10
00:00:27.239 --> 00:00:28.839
To get patients better, faster.
11
00:00:29.600 --> 00:00:32.560
We'll also talk about business strategies and tactics to help
12
00:00:32.600 --> 00:00:35.840
you work smarter and not harder, and the mindset shifts
13
00:00:35.880 --> 00:00:39.119
required to thrive as a top performer in your field
14
00:00:39.439 --> 00:00:42.000
so you can build a career you love without burning out.
15
00:00:42.840 --> 00:00:45.240
If you're ready to learn what works and what doesn't
16
00:00:45.520 --> 00:00:49.679
from leading experts, industry innovators, and respected clinicians across a
17
00:00:49.759 --> 00:00:52.920
wide range of specialties, you're in the right place.
18
00:00:52.640 --> 00:01:09.640
My friend. Let's dive in.
19
00:01:15.200 --> 00:01:17.680
Welcome back to the Factor podcast. Will we bridge the
20
00:01:17.719 --> 00:01:22.680
gap between rehabilitation performance and real world clinical practice. I'm
21
00:01:22.719 --> 00:01:26.040
your host, Jessica Riddle, and today we're continuing our two
22
00:01:26.120 --> 00:01:31.439
part conversation with doctor Pankte Fidia, DC MBA on what
23
00:01:31.560 --> 00:01:34.560
chiropractors need to know when clinical care intersects with the
24
00:01:34.640 --> 00:01:38.959
legal system. In Part one, doctor Fidia helped us understand
25
00:01:39.000 --> 00:01:43.920
the personal injury case timeline, the importance of documentation, the
26
00:01:44.000 --> 00:01:48.439
difference between clinical and legal causation, and why your notes
27
00:01:48.480 --> 00:01:53.120
may eventually become much more than clinical records. In Part two,
28
00:01:53.560 --> 00:01:57.879
we'll move deeper into what happens when those records are requested, questioned,
29
00:01:58.040 --> 00:02:02.040
or used in legal proceedings. Doctor Fidilla will walk us
30
00:02:02.079 --> 00:02:08.400
through subpoenas, affidavits, depositions, trial testimony, and the ethical issues
31
00:02:08.479 --> 00:02:11.280
chiropractors need to be aware of on working in the
32
00:02:11.360 --> 00:02:16.039
personal injury space. Shall also share practical advice for providers
33
00:02:16.039 --> 00:02:18.599
who may one day be asked to defend their documentation,
34
00:02:19.159 --> 00:02:23.319
explain their treatment decisions, or provide testimony regarding a patient's care.
35
00:02:24.439 --> 00:02:27.560
And one of the biggest themes in this episode is confidence,
36
00:02:28.080 --> 00:02:32.120
not arrogance, not overstepping your scope, and definitely not trying
37
00:02:32.120 --> 00:02:35.560
to play attorney, but the kind of professional confidence that
38
00:02:35.599 --> 00:02:39.960
comes from knowing your notes, understanding your role, and standing behind.
39
00:02:39.639 --> 00:02:40.759
The care you provided.
40
00:02:41.800 --> 00:02:46.120
Whether you regularly treat personal injury patients or only occasionally
41
00:02:46.199 --> 00:02:50.039
encounter these cases in practice. This conversation is a valuable
42
00:02:50.080 --> 00:02:54.439
reminder that preparation matters because when your documentation enters the
43
00:02:54.520 --> 00:03:01.039
legal arena, clarity, credibility, and professionalism can make all the difference. Now,
44
00:03:01.439 --> 00:03:04.159
let's get into part two of Clinics to Courtrooms with
45
00:03:04.280 --> 00:03:14.039
doctor pankt Fida.
46
00:03:15.479 --> 00:03:20.000
So let's talk about the PI case timeline. Most of
47
00:03:20.039 --> 00:03:23.599
the time, somebody will get into an accident, will hire
48
00:03:23.599 --> 00:03:26.520
an attorney, and if you work with them, that lawyer
49
00:03:26.680 --> 00:03:29.680
will send you an LOP and you're asked to schedule
50
00:03:29.759 --> 00:03:33.240
a patient, a patient will start treatment. This is pre
51
00:03:33.319 --> 00:03:38.719
litigation phase, meaning there's no ongoing case against any insurance company.
52
00:03:38.719 --> 00:03:40.960
This is where a lot of evidence is being gathered.
53
00:03:41.520 --> 00:03:44.039
That's where you come in. So all the patients that
54
00:03:44.080 --> 00:03:47.879
you're seeing while they're alive with you, the case is
55
00:03:47.919 --> 00:03:50.560
going to get into litigation. That's why your notes matter.
56
00:03:50.680 --> 00:03:53.240
But right now there's no pending case and that's all
57
00:03:53.280 --> 00:03:56.039
pre litigation. You'll hear that word a lot in practice,
58
00:03:56.199 --> 00:04:00.960
pre lit pre litigation litigation meaning once you file paperwork
59
00:04:01.000 --> 00:04:04.120
in the court. At this point, the case is being litigated,
60
00:04:04.199 --> 00:04:08.159
meaning that it's actively being worked out in the court proceedings.
61
00:04:09.000 --> 00:04:12.360
So the treatment happens at your office. You may refer
62
00:04:12.400 --> 00:04:15.520
them out to other providers. They will go do whatever
63
00:04:15.599 --> 00:04:18.439
they need to do, and at some point the treatment
64
00:04:18.839 --> 00:04:22.920
will be done. This is when attorneys will often ask
65
00:04:23.000 --> 00:04:26.360
you to send bills and records, and so you do that.
66
00:04:26.959 --> 00:04:29.800
At that point, the lawyers, the plane of attorneys will
67
00:04:29.800 --> 00:04:33.439
make a demand letter it's like a packet, and they
68
00:04:33.480 --> 00:04:36.920
will send that to the insurance company. So you'll often
69
00:04:36.959 --> 00:04:39.639
hear that from the attorneys when you're in practice, that oh,
70
00:04:39.639 --> 00:04:42.000
we are sending a demand letter soon. We need everything
71
00:04:42.079 --> 00:04:44.920
right away. And these are the words that you'll hear
72
00:04:44.959 --> 00:04:50.399
a lot. So most cases, about ninety five percent of
73
00:04:50.439 --> 00:04:54.160
the cases will that you will see will settle at
74
00:04:54.160 --> 00:04:58.160
this stage, maybe more than ninety five, let's just say
75
00:04:58.240 --> 00:05:01.240
ninety five. Approximately ninety five percent of the cases will
76
00:05:01.920 --> 00:05:04.759
be done. They'll settle. It's good. You will never have
77
00:05:04.839 --> 00:05:09.240
to worry about your documentation. Hopefully you get paid, but
78
00:05:09.600 --> 00:05:14.480
it's done. If not, the next stage is mediation and arbitration.
79
00:05:15.879 --> 00:05:19.240
This is again not litigation, but can get complicated depending
80
00:05:19.240 --> 00:05:22.160
on the jurisdiction that you're working under. But long story
81
00:05:22.240 --> 00:05:25.720
short again, it's not full blown. Let's litigate this case
82
00:05:25.759 --> 00:05:29.759
in court. They're both arguing, plain of attorneys trying to
83
00:05:29.759 --> 00:05:32.639
talk to the insurance adjusted at this point and trying
84
00:05:32.680 --> 00:05:37.079
to negotiate. So it's still mediation arbitration, this process where
85
00:05:37.319 --> 00:05:40.079
sometimes the other side, meaning that there may be a
86
00:05:40.120 --> 00:05:43.040
defense attorney at this point, both sides are meeting and
87
00:05:43.160 --> 00:05:46.439
trying to reach a resolution. Nobody wants to take cases
88
00:05:46.480 --> 00:05:50.120
to the court, even attorneys, because it's expensive, so people
89
00:05:50.199 --> 00:05:53.600
try to settle again very likely at this stage, but
90
00:05:54.079 --> 00:05:59.199
sometimes negotiations fail. So now let's talk about litigation. You
91
00:05:59.279 --> 00:06:02.120
will know that a case is in litigation when you
92
00:06:02.160 --> 00:06:05.439
will start getting and I want to use this word
93
00:06:05.480 --> 00:06:11.279
harassment from a lot of third party records retribal companies.
94
00:06:11.800 --> 00:06:14.759
If you practice personal injury, you know what I'm talking about.
95
00:06:14.920 --> 00:06:19.160
For those who don't, you will start getting third party
96
00:06:19.199 --> 00:06:23.360
companies asking you for bills and records. And this is
97
00:06:23.399 --> 00:06:27.879
not from the patient's attorney side, This is just random.
98
00:06:27.920 --> 00:06:31.120
There's companies for that. So basically your defense side is
99
00:06:31.240 --> 00:06:35.120
hiring this third party records retribal companies and they'll start
100
00:06:35.160 --> 00:06:39.639
sending you subpoenas for documents and things like that. So
101
00:06:39.759 --> 00:06:43.319
you know, okay, this is your first time knowing that
102
00:06:43.439 --> 00:06:48.160
this particular case is in litigation. Besides that, there's no
103
00:06:48.240 --> 00:06:50.439
way for you to know that because you're so busy
104
00:06:50.480 --> 00:06:52.279
in your practice. You're not going to call the law
105
00:06:52.319 --> 00:06:54.639
firm and say, hey, what's going on with this? But
106
00:06:54.720 --> 00:06:58.360
once you start seeing that, you know that, Okay, maybe
107
00:06:58.800 --> 00:07:01.319
right now they're just asking for documentation, but if they
108
00:07:01.360 --> 00:07:04.680
don't settle, there may be a point in the future
109
00:07:04.759 --> 00:07:08.399
that I may have to go and testify, either through
110
00:07:08.439 --> 00:07:14.600
deposition or in trial. Then comes the deposition segment again.
111
00:07:14.879 --> 00:07:18.600
Most other cases do settle, even in the early phases
112
00:07:18.639 --> 00:07:23.319
of litigation. But there is a process called discovery, meaning
113
00:07:23.759 --> 00:07:28.879
at this stage both parties are now exchanging evidence that
114
00:07:28.959 --> 00:07:32.480
they have and this is the time in a case
115
00:07:32.680 --> 00:07:38.040
where depositions are being taken. So there's two types of deposition.
116
00:07:39.240 --> 00:07:42.560
There's written deposition questions that you will receive, which is
117
00:07:42.639 --> 00:07:47.560
DWQ and it's mostly yes and no answers, or they
118
00:07:47.600 --> 00:07:51.240
may be asking you to produce records. Again, there's no
119
00:07:51.399 --> 00:07:54.519
live testimony here, and Catropractice are not afraid of this.
120
00:07:55.199 --> 00:07:57.519
It's normal business. Your staff can do all of that.
121
00:07:57.720 --> 00:08:02.000
They can answer the DWQS. They can do affidavits. Make
122
00:08:02.040 --> 00:08:04.959
sure you verify information. We want to know what information
123
00:08:05.000 --> 00:08:08.319
is being sent out by your staff. But it's not
124
00:08:08.480 --> 00:08:12.600
generally stressful and then comes the time when you have
125
00:08:12.680 --> 00:08:15.519
to be the post. Now, if the plaintiff attorney meaning
126
00:08:15.560 --> 00:08:20.160
your patient's lawyer, wants you to give an expert testimony,
127
00:08:20.199 --> 00:08:23.240
they'll reach out to you, generally via email. They'll ask
128
00:08:23.279 --> 00:08:26.199
you for an invoice, make sure you build them for
129
00:08:26.279 --> 00:08:29.959
your time. And this is separate from whether or not
130
00:08:30.560 --> 00:08:33.360
the lawyer receives a settlement and then you get paid
131
00:08:33.399 --> 00:08:35.320
on the lop. This is separate. This is for your
132
00:08:35.320 --> 00:08:39.320
time to give a testimony. So that's plaintiff attorney usually
133
00:08:39.360 --> 00:08:43.240
asking you an email, and you can negotiate your price
134
00:08:43.360 --> 00:08:46.679
per hour with them. All of that separately. They'll set
135
00:08:46.679 --> 00:08:50.679
a data side for you to present your deposition and
136
00:08:50.759 --> 00:08:54.639
we'll talk about depositions later. But sometimes you can get subpoena,
137
00:08:55.480 --> 00:08:58.759
meaning the other side will issue you a subpoena to
138
00:08:59.039 --> 00:09:04.679
compel you to testify. When that happens, it's not coming
139
00:09:04.720 --> 00:09:08.559
from your patient's attorney, it's coming from the other side,
140
00:09:09.639 --> 00:09:12.120
and they are not going to pay you for that.
141
00:09:12.799 --> 00:09:17.320
Practice tip that has happened to me and I. Whenever
142
00:09:17.360 --> 00:09:20.879
you get the subpoena, they somebody will come in deliver
143
00:09:21.000 --> 00:09:23.879
it to you and it will have on that subpoena.
144
00:09:23.879 --> 00:09:26.919
If you read it, it'll know who's doing who. And
145
00:09:26.960 --> 00:09:29.399
you know that you're not party to the case because
146
00:09:29.440 --> 00:09:31.720
you're not being served, you're being subpoena. You're coming in
147
00:09:31.759 --> 00:09:35.159
as a witness, so your name's nowhere on the document,
148
00:09:35.639 --> 00:09:37.759
I mean, as far as parties are concerned. And then
149
00:09:37.799 --> 00:09:40.399
you'll see what they're asking in the subpoena. They're asking
150
00:09:40.399 --> 00:09:43.759
you to give an oral testimony, and they may also
151
00:09:43.879 --> 00:09:48.080
ask you to bring documents, and it'll have the lawyer's
152
00:09:48.200 --> 00:09:51.120
name on it, both for the plaintiff and the defense,
153
00:09:51.840 --> 00:09:54.279
so you know that this is coming from the other
154
00:09:54.399 --> 00:09:57.519
side and not from the patient's attorney. You can always
155
00:09:57.519 --> 00:10:00.600
email them and ask them to come and sate you
156
00:10:00.679 --> 00:10:04.279
for your time. Again, it's hard because they are not
157
00:10:04.759 --> 00:10:08.720
legally required to pay you the defense side, but a
158
00:10:08.720 --> 00:10:11.039
lot of the times they'll say, sure, doctor, how much
159
00:10:11.080 --> 00:10:14.039
do you charge, and they'll negotiate with you and then
160
00:10:13.679 --> 00:10:15.919
you can You can reach an agreement, but you have
161
00:10:15.960 --> 00:10:19.039
to do a little bit of persistence confidence and tell
162
00:10:19.039 --> 00:10:22.279
them you're busy, because we are busy. Again, settlement can
163
00:10:22.320 --> 00:10:24.720
reach at any stage, So they may set a date
164
00:10:24.759 --> 00:10:28.039
for you to do your deposition, but they can settle
165
00:10:28.080 --> 00:10:31.840
before that. They can settle right after your deposition. You
166
00:10:31.919 --> 00:10:33.519
never know when the case is going to get settled.
167
00:10:33.519 --> 00:10:38.919
Sometimes even before the jury, right after closing arguments, a
168
00:10:38.960 --> 00:10:42.600
case can settle. So settlements can happen at any stage,
169
00:10:42.639 --> 00:10:45.320
So just be mindful of that. Just because you're you
170
00:10:45.399 --> 00:10:48.159
have a trial date and you take time off of
171
00:10:48.240 --> 00:10:50.399
work and all of that, and you may even show
172
00:10:50.440 --> 00:10:52.919
up to the court and they settle that morning. So
173
00:10:53.200 --> 00:10:56.759
I always tell my chiropractor buddies, like, if you're going
174
00:10:56.840 --> 00:11:00.720
to go to court and you're taking time off, you
175
00:11:00.919 --> 00:11:05.240
have to ask for your money for your time, even
176
00:11:05.279 --> 00:11:08.320
if they settle. So that's something that you have to
177
00:11:08.360 --> 00:11:11.120
negotiate with the plaintiff side. Of course, the defense is
178
00:11:11.159 --> 00:11:13.480
not going to negotiate with you. They don't legally have to.
179
00:11:13.799 --> 00:11:16.279
But most of the time your plane off attorneys will say, sure,
180
00:11:16.360 --> 00:11:20.519
we understand things happen, So communicate with them in writing
181
00:11:21.080 --> 00:11:23.399
and make sure that you're compensated because this is not
182
00:11:23.559 --> 00:11:27.279
part of your lob. This is extra and know your worth.
183
00:11:27.919 --> 00:11:32.559
All right, let's move on to tort law basics negligence.
184
00:11:33.039 --> 00:11:35.919
You will not hear these terms in practice, but it's
185
00:11:35.919 --> 00:11:40.000
good to understand what's going on. So when a driver
186
00:11:40.240 --> 00:11:44.279
messes up and causes an accident, you can bring a
187
00:11:44.360 --> 00:11:49.000
lawsuit against that driver and bring that insurance company into
188
00:11:49.080 --> 00:11:53.200
that case with the vehicle of negligence. That is the
189
00:11:53.320 --> 00:11:56.679
legal cause of action. And in order to prove negligence,
190
00:11:57.279 --> 00:12:03.960
a planiff attorney has to prove four things. Duty, breach, causation,
191
00:12:04.360 --> 00:12:09.000
and damages. Duty and breach is something that the lawyers
192
00:12:09.039 --> 00:12:10.600
have to worry about. So I'm not going to get
193
00:12:10.600 --> 00:12:14.360
into that, but just to explain you, duty would be
194
00:12:14.960 --> 00:12:19.360
it's my duty to be careful when I'm driving, and
195
00:12:19.600 --> 00:12:23.879
I breach that duty if I don't follow the rules,
196
00:12:24.039 --> 00:12:28.519
the traffic rules. So that's how they bring those elements
197
00:12:28.600 --> 00:12:32.480
and evidence for those elements in courtrooms where you and
198
00:12:32.559 --> 00:12:36.799
I are going to get challenged as chiropractors is causation
199
00:12:36.960 --> 00:12:40.480
and damages. So the other two buckets, causation and damages.
200
00:12:40.559 --> 00:12:44.000
That's where majority of our testimony will come into play.
201
00:12:45.320 --> 00:12:53.440
Causation is the number one battleground every defense attorney will
202
00:12:53.480 --> 00:12:56.399
target you and your notes when it comes to causation.
203
00:12:56.559 --> 00:12:59.639
They want to make it sound like the accident did
204
00:12:59.759 --> 00:13:04.399
not cause this injury. Every case they'll say it's pre existing,
205
00:13:04.919 --> 00:13:08.320
it didn't happen from the accident. That were exaggerating, or
206
00:13:08.399 --> 00:13:11.200
the client or the patient is exaggerating. That's what the
207
00:13:11.200 --> 00:13:14.240
defense will say every single time. It's a given. So
208
00:13:14.360 --> 00:13:18.360
causation is a battleground. You will use your notes to
209
00:13:18.759 --> 00:13:21.679
link causation. They will use your notes to make it
210
00:13:21.759 --> 00:13:26.080
sound like causation is poor or there's no documentation for causation.
211
00:13:26.200 --> 00:13:30.080
So remember causation very important. A lot of the chiropractors
212
00:13:30.159 --> 00:13:35.159
don't document causation at all, and we'll get into that later.
213
00:13:35.720 --> 00:13:39.960
Damages again, not battleground for sure, but not that difficult
214
00:13:40.000 --> 00:13:42.320
to prove. This is where your bills come into place.
215
00:13:42.360 --> 00:13:46.559
When they say bills and records, the records goes towards causation.
216
00:13:47.600 --> 00:13:51.720
The bills are now used to prove damages, and not
217
00:13:51.799 --> 00:13:55.720
only just your bills, but entire whatever the patient did,
218
00:13:55.759 --> 00:14:00.600
whether any er record, any medical doctor, any anybody that
219
00:14:00.639 --> 00:14:06.360
they've seen. All that becomes past medical damages. Then there
220
00:14:06.399 --> 00:14:10.039
are other types of damages that the plaintiff can bring
221
00:14:10.639 --> 00:14:14.559
future there's past medical and there's future medical. This is
222
00:14:14.559 --> 00:14:18.320
when somebody is severely injured that they're going to need
223
00:14:19.639 --> 00:14:23.159
maybe twenty four to seven nursing facility things like that.
224
00:14:23.200 --> 00:14:25.679
I'm just giving you examples, but there's also what's going
225
00:14:25.720 --> 00:14:28.679
to happen in the future. So past medical are your bills.
226
00:14:28.720 --> 00:14:33.600
Future medical is speculative in so many ways, but a
227
00:14:33.679 --> 00:14:38.080
clever attorney will try to make that evidence come in
228
00:14:38.759 --> 00:14:43.600
and get compensation for what will happen in the future.
229
00:14:44.360 --> 00:14:48.039
There's other types of non economic economic damages, which again
230
00:14:48.080 --> 00:14:51.799
you don't need to know from your perspective, but it's
231
00:14:51.840 --> 00:14:56.440
always good to know overall what happens in any negligence case.
232
00:14:58.000 --> 00:15:03.480
So let's talk about causation. Clinical causation is very different
233
00:15:03.480 --> 00:15:07.320
from legal causation. So when what we study in school
234
00:15:07.679 --> 00:15:12.679
about causation, if somebody has ridiculopathy, then you're thinking okay,
235
00:15:12.720 --> 00:15:15.679
and maybe a disc injury there, so that is your
236
00:15:16.159 --> 00:15:24.679
clinical causation. Legal causation is proving that whatever injury or
237
00:15:24.720 --> 00:15:30.120
symptoms this patient is presenting with is directly link to
238
00:15:30.320 --> 00:15:36.480
this particular accident. And it's easier said than done because
239
00:15:36.600 --> 00:15:39.720
clever defense attorney is well, like I said, they have AMMO,
240
00:15:39.799 --> 00:15:42.840
they will use everything in your notes, any kind of
241
00:15:42.960 --> 00:15:47.559
past medical history to say this is pre existing, all
242
00:15:47.600 --> 00:15:51.159
sorts of stuff. So what can we do to make
243
00:15:51.440 --> 00:15:58.960
our documentation better? You have to link the injuries to
244
00:15:59.159 --> 00:16:03.360
the accident. So if somebody got into an accident yesterday
245
00:16:03.440 --> 00:16:06.840
and they presented with neck pain, don't just say they
246
00:16:06.840 --> 00:16:09.679
got into an accident and they came with neck pain today,
247
00:16:10.799 --> 00:16:14.200
because you see there is this missing piece of evidence there.
248
00:16:14.200 --> 00:16:15.960
You have to say they got into an accident on
249
00:16:16.000 --> 00:16:20.279
this particular date and because of that accident they are
250
00:16:20.320 --> 00:16:25.559
presenting with pain today. So just simple word connecting those
251
00:16:25.600 --> 00:16:29.600
two sentences now helps your notes look better. As far
252
00:16:29.639 --> 00:16:32.720
as causation is concerned, that is because of this accident,
253
00:16:33.000 --> 00:16:37.200
the patient is presenting with this symptoms. So causing, like
254
00:16:37.320 --> 00:16:41.360
the causation aspect, very very important. Document. Make sure you
255
00:16:41.440 --> 00:16:44.399
document mechanism of injury. A lot of us don't do that.
256
00:16:45.240 --> 00:16:49.360
We just say patient presents with neck pain. Mechanism of
257
00:16:49.399 --> 00:16:53.480
injury because of car accident. Also, if there's any extremities
258
00:16:53.519 --> 00:16:57.960
involved for a regular spine injury neck and back, it's
259
00:16:58.200 --> 00:17:00.600
sort of implied at this point that if somebody has
260
00:17:00.679 --> 00:17:05.839
a car accident injury, whiplash injury, that it's neck and back.
261
00:17:05.920 --> 00:17:09.519
So we don't have to worry too much about explaining
262
00:17:09.599 --> 00:17:12.240
neck and back pain. But if they have knee pain,
263
00:17:12.400 --> 00:17:16.359
shoulder pain, ankle pain, you have to go a step
264
00:17:16.400 --> 00:17:21.079
forward and document that why. So always good practice to
265
00:17:21.160 --> 00:17:24.839
ask your patients did you hit your knee to the
266
00:17:24.920 --> 00:17:29.079
dashboard or if they present with wrist pain, explain where
267
00:17:29.200 --> 00:17:31.720
was your arm or your hand was it on the
268
00:17:31.759 --> 00:17:35.799
steering wheel? What happened? Get that information from the patient
269
00:17:36.039 --> 00:17:39.079
and document it. If they give you that information, do it.
270
00:17:39.119 --> 00:17:43.240
If they say, oh, I don't remember, but it hurts,
271
00:17:43.720 --> 00:17:46.839
then you can always document that don't remember exactly what happened,
272
00:17:46.839 --> 00:17:50.000
the accident happened too fast, but did not have any
273
00:17:50.039 --> 00:17:54.279
pain before the accident, but now after the accident, they
274
00:17:54.279 --> 00:17:57.640
said that their risk is hurting, and so that helps.
275
00:17:58.359 --> 00:18:06.079
Be truthful, but be persuasive when you're writing now timing
276
00:18:06.119 --> 00:18:10.279
of symptom manifestation again link directly towards causation. It's important
277
00:18:10.319 --> 00:18:12.920
that most of the time it depends on the case.
278
00:18:12.960 --> 00:18:16.599
If you have a case that the accident happened recently
279
00:18:16.759 --> 00:18:20.480
and you saw them two or three weeks within that timeframe.
280
00:18:21.000 --> 00:18:24.079
It's implied the timing is easy. That's a good, good story.
281
00:18:24.119 --> 00:18:28.200
But you will get cases in practice that accident happened
282
00:18:28.240 --> 00:18:31.400
six months ago and they're having pain right now. There's
283
00:18:31.440 --> 00:18:33.400
not much you can do about that as far as
284
00:18:33.519 --> 00:18:37.200
documenting causation. But you can say, ask the patient, what
285
00:18:37.319 --> 00:18:40.920
did you do for this gap that six months? Did
286
00:18:40.960 --> 00:18:44.400
you treat at home? What happened? Why were you not
287
00:18:44.480 --> 00:18:47.880
able to get treatment sooner? And then they'll tell you, oh,
288
00:18:47.880 --> 00:18:50.240
I didn't have transportation, I didn't have that. It's okay
289
00:18:50.240 --> 00:18:53.640
to document that. Like I said, be truthful. But these
290
00:18:53.680 --> 00:18:56.440
are the questions that you can ask your patient, and
291
00:18:56.480 --> 00:19:01.039
it'll make you not a regular chiropractor, but a well
292
00:19:01.079 --> 00:19:07.720
informed chiropractor who understands how to alleviate or increase the
293
00:19:07.799 --> 00:19:10.519
value of their notes. And so what you ask in
294
00:19:10.559 --> 00:19:13.799
your history matters. It's not a cookie cutter. Let me
295
00:19:13.880 --> 00:19:16.960
just ask all this accident questionnaire. No, no, no, think
296
00:19:17.799 --> 00:19:20.200
look at the date of the accident. See if there
297
00:19:20.240 --> 00:19:22.920
is gaps, try and see if you get information out
298
00:19:22.960 --> 00:19:25.799
of them to kind of connect causation there. It'll make
299
00:19:25.839 --> 00:19:31.559
your notes more valuable. Acute versus chronic symptoms.
300
00:19:30.880 --> 00:19:31.200
This is.
301
00:19:32.920 --> 00:19:36.480
So common. Every defense attorney will say, this is not
302
00:19:36.599 --> 00:19:39.160
a cute, this is chronic. That's where you're orthopedic testing
303
00:19:39.240 --> 00:19:44.160
your palpatient skills. Everything will come into play here. Your doctors,
304
00:19:44.200 --> 00:19:48.000
you know how to document acute versus chronic. But also
305
00:19:48.119 --> 00:19:52.279
know that in real life, we get our plaintiffs the
306
00:19:52.279 --> 00:19:55.079
way we get them, meaning every patient will have pre
307
00:19:55.200 --> 00:19:59.920
existing conditions and it's okay. It's fine if they have
308
00:20:00.079 --> 00:20:02.599
car accidents in the past, it's okay to document that.
309
00:20:03.079 --> 00:20:07.119
But then you can also document sure they had accident previously,
310
00:20:07.160 --> 00:20:10.480
that there's a history of car accident, but they didn't
311
00:20:10.519 --> 00:20:14.000
have much pain before this accident, and this accident exacerbated
312
00:20:14.039 --> 00:20:18.200
their symptoms. So one sentence can now say, sure, my
313
00:20:18.359 --> 00:20:22.359
patient is sixty five years old and had some arthritic
314
00:20:22.440 --> 00:20:26.240
changes in the spine, but it's doing fine, and now
315
00:20:26.359 --> 00:20:30.240
after this wreck, and if they are feeling exacerbation of symptoms,
316
00:20:30.279 --> 00:20:34.160
and then say that document that. So connecting again to
317
00:20:34.839 --> 00:20:38.720
causation will help you make your notes stronger and that
318
00:20:39.039 --> 00:20:42.440
testimony is now backed up by your notes. History of
319
00:20:42.480 --> 00:20:46.799
past pain prior collisions very very important. There's no such
320
00:20:46.839 --> 00:20:49.319
thing as hiding a bad fact, like I said, a
321
00:20:49.359 --> 00:20:52.799
lot of our patients will have multiple carrects, or they're older,
322
00:20:52.920 --> 00:20:56.480
they've got other comorbidities and other issues going on. Defense
323
00:20:56.519 --> 00:20:59.200
will point at that, and it's fine let them. You
324
00:20:59.240 --> 00:21:02.279
can always say they had those issues, but this accident
325
00:21:03.039 --> 00:21:08.839
exacerbated their symptoms, which they did. And the next in
326
00:21:08.920 --> 00:21:15.079
line is that this particular phrase, reasonable medical probability, very
327
00:21:15.160 --> 00:21:19.160
very important phrase every time a defense attorney asks you
328
00:21:19.200 --> 00:21:23.680
in person or in trial or off the record, so doctor,
329
00:21:23.720 --> 00:21:27.519
are you sure? Are you sure that this injury is
330
00:21:27.640 --> 00:21:32.039
caused by this car wreck? Are you one hundred percent sure? Well,
331
00:21:32.119 --> 00:21:34.440
let me tell you, doctors, you don't have to be
332
00:21:34.480 --> 00:21:40.559
one hundred percent sure. The legal standard is reasonable medical probability,
333
00:21:41.400 --> 00:21:46.440
meaning more likely than not, meaning if you are about
334
00:21:47.240 --> 00:21:51.640
seventy percent sure that this type of symptoms will manifest
335
00:21:51.680 --> 00:21:55.480
after a car accident. You have everything that you need
336
00:21:55.559 --> 00:21:58.119
to give that statement. You don't have to be one
337
00:21:58.200 --> 00:22:01.720
hundred percent sure that all is injuries are because of
338
00:22:01.720 --> 00:22:05.440
this accident. You just have to be more likely than
339
00:22:05.480 --> 00:22:09.039
not sure. So the standard is reasonable medical probability, and
340
00:22:09.079 --> 00:22:12.079
that you can say that with confidence. No one can
341
00:22:12.119 --> 00:22:15.680
be one hundred percent sure, can you be sure enough, Yeah,
342
00:22:15.839 --> 00:22:22.279
I have reasonable medical probability that my patient symptoms stem
343
00:22:22.319 --> 00:22:28.240
from this particular injury. Let's continue with strong documentation. Mechanism
344
00:22:28.240 --> 00:22:31.559
of injury very important. Please document that, definitely document that.
345
00:22:31.559 --> 00:22:36.480
For extremities, do your regular range of motion testing, orthopedic testing.
346
00:22:36.599 --> 00:22:39.759
You can use outcome measures also vestry, and there's so
347
00:22:39.839 --> 00:22:42.599
many out there and the it's good to use those
348
00:22:42.640 --> 00:22:46.039
because you can use that as objective data, not just
349
00:22:46.079 --> 00:22:48.279
what patient is saying. But hey, look I did all
350
00:22:48.279 --> 00:22:51.519
this testing and proof. I have evidence to show that
351
00:22:51.559 --> 00:22:55.839
they were hurting and now after treatment they've gotten better.
352
00:22:56.160 --> 00:23:00.200
Progression things like that, you can use them. Functional limitation
353
00:23:00.599 --> 00:23:04.480
very very important. Don't just document pain, also document things
354
00:23:04.480 --> 00:23:07.960
that they are not able to do. From practice perspective,
355
00:23:08.000 --> 00:23:10.440
a lot of the times my patients are saying, oh
356
00:23:10.480 --> 00:23:13.640
the pain is same or they're not giving you much.
357
00:23:13.720 --> 00:23:15.519
But if you ask them or are you able to
358
00:23:15.519 --> 00:23:19.640
do your ADLs? Can you handle cooking, cleaning house stores?
359
00:23:19.799 --> 00:23:22.279
Are you able to drive like before? Can you go
360
00:23:22.319 --> 00:23:25.240
to the gym? Depending on patient's age and in their
361
00:23:25.279 --> 00:23:29.079
functional activity status before the accident, good questions to ask
362
00:23:29.240 --> 00:23:31.160
and these are the things that you can ask every
363
00:23:31.240 --> 00:23:33.920
time they come in and document it on your soap
364
00:23:33.960 --> 00:23:37.079
notes to saying functional limitations, things that are not able
365
00:23:37.119 --> 00:23:39.880
to do like they used to before the accident. Good
366
00:23:39.960 --> 00:23:44.799
good documentation. Progression of care. This is something that will
367
00:23:44.839 --> 00:23:49.680
help you when defense will try to make it sound
368
00:23:49.799 --> 00:23:54.400
like your care is redundant or not medically necessary or
369
00:23:54.519 --> 00:23:58.440
excessive when they say, well, doctor, did you really need
370
00:23:58.480 --> 00:24:04.240
to see this patient twenty something times? Yes? And why?
371
00:24:04.680 --> 00:24:08.160
Progression of care so you don't just say pain levels
372
00:24:08.200 --> 00:24:11.839
went down. Also say functional limitations that you documented early
373
00:24:12.279 --> 00:24:15.519
are now getting better. If they're getting better, also use
374
00:24:15.640 --> 00:24:19.480
your outcome measures, do it again, re examine things like
375
00:24:19.519 --> 00:24:23.240
that to show medical necessity. This is how you build
376
00:24:23.400 --> 00:24:27.880
strong documentation to kind of justify the number of treatments
377
00:24:27.920 --> 00:24:34.359
that you're giving this particular patient. Updated diagnosis. I have
378
00:24:34.559 --> 00:24:38.759
seen so many chiropractors. I don't know if this is
379
00:24:38.880 --> 00:24:42.599
lazy conduct or I don't know why, but a lot
380
00:24:42.640 --> 00:24:45.839
of chiropractors stop doing re examination and they're not updating
381
00:24:45.839 --> 00:24:50.240
diagnosis once they get the imaging results back. So we
382
00:24:50.319 --> 00:24:53.880
send out for let's say MRI. You're suspecting that there
383
00:24:53.960 --> 00:24:57.279
is a bulging disc her needed disc Now you have
384
00:24:58.039 --> 00:25:01.000
confirmation on the MRI that they do, you go back
385
00:25:01.039 --> 00:25:05.319
and change your diagnosis. Added, it's important to update diagnosis
386
00:25:05.359 --> 00:25:09.400
that shows that this is not just a regular cookie
387
00:25:09.400 --> 00:25:12.200
cutter case that everybody has the same Diagno. No, I
388
00:25:12.279 --> 00:25:17.920
am changing my treatment plan based off of whatever imaging
389
00:25:17.960 --> 00:25:22.559
I'm getting, and I'm also updating diagnosis. And so your
390
00:25:22.640 --> 00:25:26.319
initial diagnosis is there, but then you kind of refine
391
00:25:26.359 --> 00:25:30.160
it depending on what happens next, depending on the imaging finding.
392
00:25:30.200 --> 00:25:33.279
So if somebody may have a specific right now, maybe
393
00:25:33.279 --> 00:25:37.400
you just documented sprain strain at the shoulder, but now
394
00:25:37.480 --> 00:25:42.680
you know exactly which muscle, then be more specific. It's
395
00:25:42.720 --> 00:25:44.960
hard to do in practice. Trust me, I've been doing
396
00:25:45.000 --> 00:25:46.920
this for eight years. I see a lot of new
397
00:25:46.920 --> 00:25:48.759
patients a month and it's just, oh, I have to
398
00:25:48.799 --> 00:25:51.720
do this again. But you have to because it's good
399
00:25:51.920 --> 00:25:55.519
and it also gives you strong notes to defend, and
400
00:25:55.559 --> 00:25:58.480
then you can alter your treatment plan based off of
401
00:25:58.680 --> 00:26:01.440
what's going on. You can docum in that Okay, I
402
00:26:01.519 --> 00:26:04.160
suspected that there was sprain strain on the shoulder, but
403
00:26:04.240 --> 00:26:07.880
now I know that there is I don't know super
404
00:26:07.880 --> 00:26:11.039
spinnatus tair. So we've added this kind of exercises to
405
00:26:11.160 --> 00:26:14.279
rehab that, and so that adds value to your notes
406
00:26:14.839 --> 00:26:21.079
and consistency. Again, because of the EHRs WUS Cairo touch
407
00:26:21.160 --> 00:26:25.079
or there's so many out there, there can be inconsistency,
408
00:26:25.599 --> 00:26:28.319
so be mindful of that. Like let's say you forgot
409
00:26:28.319 --> 00:26:31.880
to add the soap and you went back and you
410
00:26:31.920 --> 00:26:34.680
added it, and everything from the first two visits kind
411
00:26:34.720 --> 00:26:38.440
of rolled back into this one. So your visit fifteen
412
00:26:38.799 --> 00:26:42.559
has the same level of pains as visit second, and
413
00:26:42.680 --> 00:26:45.519
on the sixteenth again it dropped down to like nothing.
414
00:26:45.680 --> 00:26:48.960
So be careful. You're very busy, and there may be
415
00:26:49.079 --> 00:26:51.519
sometimes your staff is doing the soaps for you. So
416
00:26:52.119 --> 00:26:54.400
you as the doctor, you're the one who's responsible for
417
00:26:54.440 --> 00:26:56.440
your notes. You're the one who's signing it, so it
418
00:26:56.519 --> 00:26:59.920
has to sound consistent. Make sure if there are gaps
419
00:27:00.160 --> 00:27:04.720
treatment that you document that in things like that, common
420
00:27:04.759 --> 00:27:09.839
documentation mistakes, copy paste notes. This happens a lot in practice.
421
00:27:10.160 --> 00:27:13.480
And when you'll find people that are in the same crash,
422
00:27:13.920 --> 00:27:16.839
like four people in the same car crash, right, and
423
00:27:17.559 --> 00:27:21.640
all four of them have the same identical diagnosis list.
424
00:27:22.279 --> 00:27:27.680
They have same muscular skeletal findings, and some things are
425
00:27:27.720 --> 00:27:31.440
going to be the same. If you treat athletes and
426
00:27:31.519 --> 00:27:34.519
you're treating concussion, a lot of the documentation is going
427
00:27:34.559 --> 00:27:37.160
to be the same. So that's my argument always like, hey,
428
00:27:37.200 --> 00:27:40.200
I'm a chiropractor, I see muscular skelet injuries, I treat
429
00:27:40.240 --> 00:27:43.000
car accident patients. A lot of these things are going
430
00:27:43.039 --> 00:27:45.480
to be the same. My choice of orthopedic testing are
431
00:27:45.519 --> 00:27:48.559
going to be the same. But there has to be
432
00:27:48.640 --> 00:27:51.440
some things that are different, right, because every human being
433
00:27:51.519 --> 00:27:55.480
is different. So that is your job to be the
434
00:27:55.519 --> 00:27:58.400
best doctor that you are. Use all the training that
435
00:27:58.440 --> 00:28:03.200
you're chiropractical school taught you, and in document things that
436
00:28:03.240 --> 00:28:06.519
are different. Don't be copy pasting notes. Try to find
437
00:28:07.119 --> 00:28:10.920
individualistic finding. It can be very simple like pel patient
438
00:28:11.000 --> 00:28:15.920
finding something that is unique to that particular patient. That's
439
00:28:16.000 --> 00:28:20.039
one way to negate the allegation of copy paste notes.
440
00:28:20.720 --> 00:28:24.480
Gaps in care very very important. This is where defense
441
00:28:24.519 --> 00:28:28.359
will come in and say your patient is not hurting,
442
00:28:28.839 --> 00:28:31.640
Your client is not hurting, they are not coming in,
443
00:28:32.200 --> 00:28:34.359
or you have not seen them in three months. You
444
00:28:34.440 --> 00:28:37.400
never did it re exam. So gaps in care is
445
00:28:37.480 --> 00:28:40.599
always a problem. We can't control this. You can't force
446
00:28:40.640 --> 00:28:44.240
your patient to come in. You can recommend them. That's
447
00:28:44.279 --> 00:28:46.000
the best you can do. So do your best to
448
00:28:46.240 --> 00:28:50.839
document gaps in care. Ask them what happened, didn't have transportation, rated,
449
00:28:51.559 --> 00:28:55.039
was traveling? Was sick this that the other. If they
450
00:28:55.039 --> 00:28:57.799
give you answers, document and do your best. If they
451
00:28:57.799 --> 00:29:00.160
don't give you answers, there's nothing you can do. It's
452
00:29:00.200 --> 00:29:03.119
not much you can control in this area. But educating
453
00:29:03.200 --> 00:29:07.640
your patient is important. Definitely communicate with them, have your
454
00:29:07.640 --> 00:29:11.440
staff communicate with them. Let them know gaps is bad,
455
00:29:11.519 --> 00:29:15.920
bad bad. And if there's a really humongous gap, like
456
00:29:16.000 --> 00:29:20.559
re exam, please please do a re exam. Inconsistency We
457
00:29:20.640 --> 00:29:25.559
talked about that already. Over and undertreatment another way. Defense
458
00:29:25.599 --> 00:29:29.200
will like to target our notes. They'll always say they'll
459
00:29:29.240 --> 00:29:33.079
always say you treat them way too many times, and
460
00:29:33.559 --> 00:29:36.480
lately they're saying undertreatment, which is a new one that
461
00:29:36.519 --> 00:29:39.240
I'm seeing. So yeah, they will always attack you on that.
462
00:29:40.279 --> 00:29:43.480
Be confident in responding to these answers. If you documented
463
00:29:43.559 --> 00:29:46.960
that many visits, you documented that many wizards, it's industry standard.
464
00:29:47.440 --> 00:29:51.319
Stick with it. Be confident when you answer these questions.
465
00:29:51.359 --> 00:29:54.559
If you yourself seem defeated when answering those questions and
466
00:29:54.599 --> 00:29:57.200
you feel like, I don't think if you're not confident
467
00:29:57.200 --> 00:29:59.000
in your own notes, like, how are you going to
468
00:29:59.000 --> 00:30:03.160
convince a jury, let alone a defense attorney. So make
469
00:30:03.240 --> 00:30:06.519
sure that if you set a treatment plan that you
470
00:30:06.519 --> 00:30:10.039
are one hundred percent by it. I don't want to
471
00:30:10.079 --> 00:30:12.440
say what number is, Okay, one number is not. It
472
00:30:12.480 --> 00:30:17.680
really depends on the patient. We are. We're very patient
473
00:30:17.799 --> 00:30:20.759
centric and we make the decision based on the client,
474
00:30:20.799 --> 00:30:24.559
on the patient, not like this scale of this number
475
00:30:24.599 --> 00:30:27.119
of sessions for every patient. Now it's just patient dependent
476
00:30:27.559 --> 00:30:30.960
and it depends on many, many, many, many factors. Comorbidities
477
00:30:31.039 --> 00:30:34.319
and age of the patient, how active they are, the
478
00:30:34.680 --> 00:30:38.440
severity of their injuries, things like that. Okay, last, but
479
00:30:38.519 --> 00:30:42.359
not the least. Please please, Caidropractice, if you take one thing,
480
00:30:43.160 --> 00:30:48.839
one thing from this webinar, do not do not document
481
00:30:50.039 --> 00:30:54.200
attorney driven care. What do I mean by that? I
482
00:30:54.279 --> 00:31:00.000
have seen notes where Caidropractice are written attorney denied, MRIs,
483
00:31:00.759 --> 00:31:08.400
attorney approved, MRI, attorney did not approve additional treatments. Please
484
00:31:08.480 --> 00:31:10.960
don't document that. It's common sense, but people do it
485
00:31:11.000 --> 00:31:14.400
all the time. I understand what you're trying to communicate there.
486
00:31:14.519 --> 00:31:16.920
Maybe there is some way, you're trying to document that
487
00:31:17.000 --> 00:31:21.359
I did my due diligence. I think the patient needs MRI,
488
00:31:21.599 --> 00:31:24.960
but the attorney denied it. When you document things like that,
489
00:31:25.200 --> 00:31:28.480
you're saying that it's attorney driven medical care, and that's
490
00:31:28.519 --> 00:31:31.039
going to be a big no no. It's a major
491
00:31:31.079 --> 00:31:34.440
red flag, not only for that case that you're asked
492
00:31:34.480 --> 00:31:38.799
to give a deposition for, but overall, for overall ethics.
493
00:31:39.279 --> 00:31:42.480
We can't have attorneys practice medicine. We can't have attorney's
494
00:31:42.559 --> 00:31:47.039
practice chiropractic care. It's your call, So please refrain from
495
00:31:47.039 --> 00:31:51.039
documenting that. Even internally, a lot of these internal notes
496
00:31:51.079 --> 00:31:55.839
are now being discoverable, So be very careful if imagine
497
00:31:55.839 --> 00:31:58.240
that these documents are being read in court and you
498
00:31:58.440 --> 00:32:00.480
not want to write something that you can get in
499
00:32:00.559 --> 00:32:06.680
trouble with. Let's talk about affidavits and subpoenas. So subpoenas,
500
00:32:06.720 --> 00:32:09.200
like we already discuss, you can get subpoena by the
501
00:32:09.200 --> 00:32:12.880
defense attorney to come and give a deposition. Besides that,
502
00:32:13.039 --> 00:32:16.559
you can also have subpoenas for documents, records. Trival companies,
503
00:32:16.599 --> 00:32:20.000
third party companies will give you those subpoenas, and they
504
00:32:20.000 --> 00:32:24.119
can be really broad if they are asking for information
505
00:32:24.279 --> 00:32:29.079
such as your internal notes or your communication with the
506
00:32:29.119 --> 00:32:34.240
plaintiff attorneys. That's too broad of a skull and they
507
00:32:34.279 --> 00:32:37.279
should not be asking, but they will, so I recommend
508
00:32:37.279 --> 00:32:39.839
that if you feel like they're fishing for information, reach
509
00:32:39.839 --> 00:32:41.799
out to the planeff attorneys. Sometimes you may have to
510
00:32:41.799 --> 00:32:45.480
get your own lawyer to quash those because that's not right.
511
00:32:46.200 --> 00:32:49.680
But they'll try their best, and it's annoying, but we
512
00:32:49.759 --> 00:32:52.200
all have to deal with that. You can charge them
513
00:32:52.680 --> 00:32:57.839
for providing them with records reasonable fee, and they're not
514
00:32:57.880 --> 00:33:03.000
your friends, so it's okay to buy time and make
515
00:33:03.039 --> 00:33:05.960
it difficult for them. Sometimes I ask them I will
516
00:33:05.960 --> 00:33:09.160
release it once your check is cleared to make sure
517
00:33:09.200 --> 00:33:11.720
I'm getting paid for it. But yep, you will see
518
00:33:11.720 --> 00:33:14.519
that a lot in practice, so be careful. You don't
519
00:33:14.559 --> 00:33:17.920
have to worry about doing them yourselves, especially the written
520
00:33:18.000 --> 00:33:20.759
questions that yes and no, the dwqs. Your staff can
521
00:33:20.799 --> 00:33:23.359
do them. Your staff can sign them, but at the
522
00:33:23.440 --> 00:33:25.319
end of the day, your license on the line, so
523
00:33:25.480 --> 00:33:28.480
I always review it. If it's standard, they'll know what
524
00:33:28.559 --> 00:33:32.039
to do. But if they're asking for very detailed, complicated language,
525
00:33:32.680 --> 00:33:36.960
look it up. Hire a lawyer if you need to depositions,
526
00:33:37.000 --> 00:33:40.680
we have to do another seminar, but yeah, depositions basically
527
00:33:41.119 --> 00:33:44.480
plain if attorney or defense attorney asking you questions, it's
528
00:33:44.640 --> 00:33:49.759
testimony under oath. It can be online what in person.
529
00:33:49.960 --> 00:33:52.400
Back in those days, they used to come into your
530
00:33:52.400 --> 00:33:54.400
office and do it. Now most of these are done
531
00:33:54.440 --> 00:33:57.039
on zoom, but they can still come in office and
532
00:33:57.079 --> 00:34:00.000
do it. It's not done in the court. It's testimony
533
00:34:00.119 --> 00:34:04.400
outside the court. But because it's it's basically testimony that
534
00:34:04.440 --> 00:34:06.519
can be used in court. So if you're not going
535
00:34:06.559 --> 00:34:09.119
to be available to give your life testimony in court,
536
00:34:09.400 --> 00:34:12.639
a lot of the times it's recorded in a deposition setting,
537
00:34:12.760 --> 00:34:15.599
and that way they can use that instead of you
538
00:34:15.719 --> 00:34:18.920
going to court. The court reborder's presence, so everything that
539
00:34:19.000 --> 00:34:22.800
you say is going to be transcribed, and every time
540
00:34:22.800 --> 00:34:26.440
you say and and all of that also gets documented.
541
00:34:26.519 --> 00:34:29.960
So sometimes when you read it, like ah, it sounds cringe,
542
00:34:30.000 --> 00:34:33.119
but it's the nature of the game, and so it's
543
00:34:33.159 --> 00:34:37.000
important that you prepare for deposition. It can be really long,
544
00:34:37.559 --> 00:34:41.840
anywhere between two to six hours depending on the case,
545
00:34:42.360 --> 00:34:44.639
and it can be used for more than one case.
546
00:34:44.679 --> 00:34:47.320
Doctors don't really pay attention to that, but it is true,
547
00:34:47.480 --> 00:34:49.679
a deposition that you may have given two years ago
548
00:34:49.800 --> 00:34:54.679
for this particular attorney can be used for a case
549
00:34:54.679 --> 00:34:57.159
that's coming up three years from now, or if they're
550
00:34:57.199 --> 00:35:00.800
trying to find or come after you, they can use that.
551
00:35:00.920 --> 00:35:04.960
So that's deposition. We have to do another webinar for that.
552
00:35:05.159 --> 00:35:08.480
But you can always use your own lawyer if you're
553
00:35:08.519 --> 00:35:13.000
really intimidated or you feel like they're trying for you
554
00:35:13.079 --> 00:35:15.880
to give statements that has nothing to do with the
555
00:35:15.920 --> 00:35:18.840
case that you're being called to do a deposition for.
556
00:35:19.159 --> 00:35:22.239
So it's this person'suing this person. You are a fact witness,
557
00:35:22.639 --> 00:35:25.519
but they're asking you all the questions pertaining to where
558
00:35:25.559 --> 00:35:29.440
you're working and other stuff has nothing to do with that,
559
00:35:29.639 --> 00:35:33.440
and you're suspecting some kind of weird things happening. Yeah,
560
00:35:33.599 --> 00:35:35.960
just call an attorney have them come in. There's so
561
00:35:36.079 --> 00:35:38.360
much more that lawyers can do to protect you in
562
00:35:38.360 --> 00:35:41.559
a deposition settings, but majority of the times is related
563
00:35:41.559 --> 00:35:44.039
to the case. You can charge them a reasonable fee
564
00:35:44.320 --> 00:35:47.039
and you can give you a testimony and be confident
565
00:35:47.039 --> 00:35:50.599
in giving the testimony. Defense will try to attack your
566
00:35:50.599 --> 00:35:53.400
credibility and deposition. Main thing they'll try to say, you
567
00:35:53.440 --> 00:35:57.280
don't know what you're talking about that it's all attorney
568
00:35:57.360 --> 00:36:01.639
driven treatment. Everything is overtreatment for them. They'll say the
569
00:36:01.679 --> 00:36:06.599
treatments are not medically necessary. They'll say, or MRIs if
570
00:36:06.599 --> 00:36:10.320
we're not necessary, that you have a financial gain or
571
00:36:10.400 --> 00:36:15.119
incentive for sending them out for imaging testing. They'll attack
572
00:36:15.159 --> 00:36:17.920
you in a scope of practice. These are for dcs
573
00:36:17.960 --> 00:36:20.679
that have a DC and P setting that they are
574
00:36:20.719 --> 00:36:24.039
doing not only chiropractic care, but also a little bit
575
00:36:24.079 --> 00:36:26.519
of medical in there, so they'll try to attack you
576
00:36:26.559 --> 00:36:31.559
on those. They'll find documentation gaps, and then long story short,
577
00:36:31.719 --> 00:36:34.119
the goal for deposition is to make you look like
578
00:36:35.480 --> 00:36:38.360
you're not smart enough or you're lying in front of
579
00:36:38.360 --> 00:36:41.440
the jury and our jury, depending on the jurisdiction that
580
00:36:41.480 --> 00:36:46.159
you're from, sometimes there's a jury bias. Still people think
581
00:36:46.199 --> 00:36:50.159
that chiropractic care is not as credible as medical care.
582
00:36:50.360 --> 00:36:53.840
That they think that we're not perfect doctors or good
583
00:36:53.880 --> 00:36:57.360
doctors or real doctors, and so they will try to
584
00:36:57.400 --> 00:36:59.920
attack you on the jury bias. So what do you do?
585
00:37:00.079 --> 00:37:04.719
You talk about your amazing education that your school gave you,
586
00:37:04.840 --> 00:37:08.639
all the science classes that you've taken, and that you've
587
00:37:08.679 --> 00:37:11.280
been doing this with this many years and when you
588
00:37:11.320 --> 00:37:14.480
start talking and you're using just the right amount of
589
00:37:14.760 --> 00:37:19.519
medical knowledge with plain language that somebody else will understand,
590
00:37:19.760 --> 00:37:22.760
then this goes away so very quickly, the jewry bias
591
00:37:22.840 --> 00:37:26.079
goes away as they start listening to you. You have
592
00:37:26.119 --> 00:37:30.039
to sound smart and confident, because guys, understand this. You're
593
00:37:30.079 --> 00:37:32.760
not giving a testimony to your professors. You're giving a
594
00:37:32.760 --> 00:37:39.039
testimony to a juror that whose education level is probably
595
00:37:39.079 --> 00:37:42.079
no more than ninth grade education, and that's what they
596
00:37:42.079 --> 00:37:43.599
did us in law school. So you have to use
597
00:37:43.599 --> 00:37:48.320
simple language and not sound arrogant, but also at the
598
00:37:48.360 --> 00:37:53.559
same time confident and explain them what chiropractors do and
599
00:37:53.599 --> 00:37:56.760
how we help this patient, and be confident. Whether that's
600
00:37:56.800 --> 00:38:01.119
deposition or life testimony. It's important that you believe in
601
00:38:01.159 --> 00:38:06.039
your treatment and you believe that you're in a profession
602
00:38:06.119 --> 00:38:08.960
to help people. And it radiates in the way you
603
00:38:09.000 --> 00:38:13.719
communicate how to have handled a position. Answer only what
604
00:38:13.880 --> 00:38:19.199
is asked. Please remember, defense counsel not your friend. Plaintiff
605
00:38:19.239 --> 00:38:23.159
counsel also not your friend. You are not here to
606
00:38:23.239 --> 00:38:25.840
build a case for them. You're just defending your notes.
607
00:38:25.880 --> 00:38:29.320
You're not really defending the client. That's the lawyer's job.
608
00:38:29.840 --> 00:38:33.639
Let the lawyer defend the patient. Let the lawyer make
609
00:38:33.920 --> 00:38:36.559
or break the case for the patient. Your job is
610
00:38:36.639 --> 00:38:40.039
to stay focused on your notes, so answer only what
611
00:38:40.199 --> 00:38:45.280
is asked, stay within your scupe. Plaintiff attorneys are notorious
612
00:38:45.719 --> 00:38:48.679
for asking you questions that are outside your scope. Your
613
00:38:48.719 --> 00:38:51.599
patients attorney will ask you, so, doctor, do you think
614
00:38:51.760 --> 00:38:55.800
the surgery was necessary? Or do you think the surgical
615
00:38:55.880 --> 00:39:01.119
bills are industry standard? Or they'll ask you about accident reconstruction,
616
00:39:01.760 --> 00:39:05.000
and it can get murky. Sometimes you have credentials to
617
00:39:05.039 --> 00:39:08.400
talk about it, depending on the person who's doing the
618
00:39:08.519 --> 00:39:11.519
depending on the doctor. Some doctors don't. And so it's
619
00:39:11.519 --> 00:39:15.119
okay to say that's not within my scope. It's fine
620
00:39:15.159 --> 00:39:17.360
even if that upsets them, that's okay. But stay within
621
00:39:17.400 --> 00:39:20.400
your scope. That will protect your license and your credibility.
622
00:39:20.639 --> 00:39:24.000
It's okay to say I don't know, please do not guess.
623
00:39:24.280 --> 00:39:27.880
That again, goes down to credibility. If you're honest, people
624
00:39:27.960 --> 00:39:31.159
can see that. Defend your notes, not the patient, very
625
00:39:31.239 --> 00:39:34.000
very important. Don't go out of your way in making
626
00:39:34.039 --> 00:39:36.519
a case for the patient. That is not your job.
627
00:39:36.599 --> 00:39:38.360
Let the lawyers do that. If they're a good lawyer.
628
00:39:38.400 --> 00:39:42.079
They can handle it. If there's a bad fact, it's okay.
629
00:39:42.320 --> 00:39:44.280
Let the lawyer be the lawyer. You're not the lawyer,
630
00:39:44.360 --> 00:39:48.440
you are the doctor. You are defending your notes. Please
631
00:39:48.480 --> 00:39:51.400
do not lie because that's perjury. You can use a
632
00:39:51.480 --> 00:39:54.719
license for that, So no lying. If you don't know
633
00:39:54.800 --> 00:39:57.000
it can always say I don't know. It's based off
634
00:39:57.039 --> 00:40:00.920
of your personal knowledge. If you don't have the person knowledge,
635
00:40:01.239 --> 00:40:03.880
don't answer it. Just say I don't know. It's okay
636
00:40:03.920 --> 00:40:08.239
to say that. Trial testimony looks very similar to deposition testimony,
637
00:40:08.239 --> 00:40:10.960
but it's high stakes. Why because it's live. In trial,
638
00:40:11.039 --> 00:40:13.719
there is a judge there. In depositions, you don't have
639
00:40:13.760 --> 00:40:16.599
a judge, so even if the other side objects, there
640
00:40:16.639 --> 00:40:19.320
is no life ruling on the objection, But in trial
641
00:40:19.400 --> 00:40:23.280
testimony there is. Which makes it easy for us as
642
00:40:23.639 --> 00:40:26.679
experts to give our testimony because it's short. They're not
643
00:40:26.760 --> 00:40:29.119
going to hold you in court for four or five hours.
644
00:40:29.119 --> 00:40:31.239
You may be waiting for your turn, but you're not
645
00:40:31.360 --> 00:40:34.440
giving a testimony for that long. It's pretty quick. It's fast,
646
00:40:34.920 --> 00:40:38.199
it's very jury focused. So simple language is the key.
647
00:40:38.320 --> 00:40:42.679
You have to sound confident but not arrogant to you
648
00:40:42.719 --> 00:40:45.760
don't have to be necessarily charming, but you don't also
649
00:40:45.840 --> 00:40:51.559
have to sound or somebody who's industry expert. Like you're
650
00:40:51.599 --> 00:40:54.840
not giving a testimony to your professors of your chiapractic school.
651
00:40:55.119 --> 00:40:58.639
You're talking to somebody that will believe everything that you're
652
00:40:58.679 --> 00:41:01.760
saying if you're saying it right. So make sure that
653
00:41:02.079 --> 00:41:05.719
you understand who your audience is. That adds value to
654
00:41:05.760 --> 00:41:08.920
your testimony. If I'm giving a testimony to my professor,
655
00:41:08.960 --> 00:41:12.320
I'm going to be scared because i have to justify everything.
656
00:41:12.400 --> 00:41:15.360
But when I'm answering it to my mom or I'm
657
00:41:15.400 --> 00:41:18.079
explaining why I'm to my patient, for example, why I'm
658
00:41:18.079 --> 00:41:20.119
explaining to my patient why you need to come in
659
00:41:20.119 --> 00:41:22.400
for this many number of visits, I'm able to do
660
00:41:22.440 --> 00:41:26.440
it more confidently. So always remember that your audience last,
661
00:41:26.440 --> 00:41:27.199
but not the least.
662
00:41:37.280 --> 00:41:40.679
That wraps up Part two of our conversation with doctor Panktyfidia.
663
00:41:41.320 --> 00:41:44.679
In this episode, we move beyond documentation and into the
664
00:41:44.679 --> 00:41:50.760
realities of subpoenas, records requests, depositions, trial testimony. We talked
665
00:41:50.800 --> 00:41:55.199
about expert witness, credibility and the ethical considerations that come
666
00:41:55.280 --> 00:41:59.440
with working in the PI or personal injury space. One
667
00:41:59.480 --> 00:42:02.840
of the biggest takeaways from this conversation is that chiropractors
668
00:42:02.920 --> 00:42:05.920
don't need to be afraid of the legal process, but
669
00:42:06.000 --> 00:42:10.400
they do need to be prepared. That means knowing your documentation,
670
00:42:10.559 --> 00:42:15.159
staying within your scope, answering only what is asked, avoiding speculation,
671
00:42:15.679 --> 00:42:18.639
and understanding that your job is not to defend the
672
00:42:18.679 --> 00:42:24.239
patient's entire case your job, your most important role, is
673
00:42:24.280 --> 00:42:28.679
to explain and support the care that you provided. Doctor
674
00:42:28.679 --> 00:42:32.760
Fidia also gave an important reminder that professional credibility starts
675
00:42:32.840 --> 00:42:37.920
long before a deposition or courtroom testimony. It starts in
676
00:42:37.960 --> 00:42:41.960
the exam room, in your clinical reasoning, in your documentation habits,
677
00:42:42.360 --> 00:42:44.800
and in the way you communicate your role as a
678
00:42:44.800 --> 00:42:50.079
healthcare provider. And perhaps most importantly, this episode is a
679
00:42:50.119 --> 00:42:53.960
reminder for healthcare providers to take pride in the value
680
00:42:54.000 --> 00:42:58.800
of conservative care when documented clearly and delivered ethically. The
681
00:42:58.840 --> 00:43:02.760
work that you do not only for the patient's recovery,
682
00:43:02.840 --> 00:43:06.519
but also for how that care is understood and represented
683
00:43:06.599 --> 00:43:10.679
when it becomes part of a larger legal process. A
684
00:43:10.760 --> 00:43:14.239
huge thank you to doctor Panktifidia for sharing her unique
685
00:43:14.239 --> 00:43:17.920
perspective as both a practicing chiropractor and a soon to
686
00:43:17.960 --> 00:43:21.320
be attorney and for helping providers better understand how to
687
00:43:21.400 --> 00:43:26.079
navigate this complex intersection of healthcare and law. As always,
688
00:43:26.199 --> 00:43:29.559
thanks for listening to the Factor podcast. Be sure to subscribe,
689
00:43:29.760 --> 00:43:32.920
follow or share this episode with a colleague or friend,
690
00:43:33.480 --> 00:43:37.000
and we will look forward to seeing you next time.
691
00:43:40.880 --> 00:43:42.840
Hey guys, if you like what you heard today, I
692
00:43:42.920 --> 00:43:46.480
encourage you to visit our website at Factor hyphenstore dot
693
00:43:46.480 --> 00:43:52.639
com that's spelled fa k tr hyphenstore dot com to
694
00:43:52.679 --> 00:43:55.239
find out more information about all that we have to offer.
695
00:43:55.440 --> 00:43:57.800
We have a variety of online offerings as well as
696
00:43:57.800 --> 00:44:01.199
our hands on Factor Rehab System Core scheduled in cities
697
00:44:01.239 --> 00:44:03.320
around the globe. Be sure to also check out our
698
00:44:03.320 --> 00:44:06.800
event calendar and bookmark any of these upcoming live webinar
699
00:44:06.880 --> 00:44:09.079
dates coming up in the near future so you can
700
00:44:09.159 --> 00:44:11.519
join us live. And of course, the biggest compliment we
701
00:44:11.559 --> 00:44:13.480
can receive is for you to help us spread the
702
00:44:13.519 --> 00:44:16.760
word to your friends, colleagues, and classmates. You'll find all
703
00:44:16.800 --> 00:44:19.360
the important links, as well as info about our sponsors
704
00:44:19.400 --> 00:44:21.519
in the show notes, so be sure to check those out.
