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The MVA Patient -. Your Favourite !. Why Family Doctors?. Why Family Doctors?. experts in Family Medicine. Why Family Doctors?. experts in Family Medicine know the patient best. Why Family Doctors?. experts in Family Medicine know the patient best
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The MVA Patient - Your Favourite!
Why Family Doctors? • experts in Family Medicine
Why Family Doctors? • experts in Family Medicine • know the patient best
Why Family Doctors? • experts in Family Medicine • know the patient best • jurors have family doctors and tend to relate to them well
Why Family Doctors? • experts in Family Medicine • know the patient best • jurors have family doctors and tend to relate to them well • experience with chronic conditions
In What Types of Cases? • “chronic pain” personal injury cases
In What Types of Cases? • “chronic pain” personal injury cases • “before and after”
In What Types of Cases? • “chronic pain” personal injury cases • “before and after” • clarify impact of pre-existing impairments
In What Types of Cases? • “chronic pain” personal injury cases • “before and after” • clarify impact of pre-existing impairments • explain clinical course
CAUSATION • did the MVA cause the pt’s symptoms?
CAUSATION • did the MVA cause the pt’s symptoms? • consideration of pt’s prior hx
CAUSATION • did the MVA cause the pt’s symptoms? • consideration of pt’s prior hx • line between pre-accident and post-accident hx is blurry
CAUSATION • did the MVA cause the pt’s symptoms? • consideration of pt’s prior hx • line between pre-accident and post-accident hx is blurry • accident need not be the sole or direct cause of symptoms
CAUSATION • “material contribution” Supreme Court of Canada says: ‘Where the “but for” test is unworkable, the courts have recognized that causation is established where the defendant’s negligence “materially contributed” to the occurrence of the injury.’
CAUSATION • positive scientific proof not required
CAUSATION • positive scientific proof not required • recognizes multifactorial nature of many conditions
“INJURY vs. IMPAIRMENT” • emphasis on impairment, not injury
“INJURY vs. IMPAIRMENT” • emphasis on impairment, not injury • no functional impairment = no case
“INJURY vs. IMPAIRMENT” • emphasis on impairment, not injury • no functional impairment = no case • injuries heal but impairments remain, e.g. chronic pain
“INJURY vs. IMPAIRMENT” • emphasis on impairment, not injury • no functional impairment = no case • injuries heal but impairments remain, e.g. chronic pain • do impairments interfere with daily life tasks?
Mrs […] is a patient of this medical clinic under my care. I have been asked to provide some further information as to her level of functioning before and after the accident that she sustained on September 3 1998. • Nature of document • medical-legal report • requested by legal representative
I am a qualified medical practitioner, licensed to practice in the Province of Ontario. I graduated from the University of Western Ontario Faculty of Medicine in 1993 and received my certification as a Family Practitioner from the Canadian College of Family Physicians in 1995. • Summary of qualifications
Mrs. […] has been a patient of mine since July 31 1996. • first contact
When I met her she was quite a functional lady with a history of Paget's disease that was under reasonable control and a previous history of several abdominal surgeries. In general though, visits to the office were over minor concerns such as upper respiratory tract infections. • pt’s past hx
On September 4 1998 Mrs […] was seen in the office the day after an accident that happened to her in a store when a rack of picture frames fell on her injuring her right shoulder. • first meeting post-event
own examination and findings At that time an examination was carried out and x-rays were obtained which did not show a clinical fracture.
list complaints and… In short any activity that involves the use of her hands and arms causes pain in the shoulder girdle area. This presents a problem for simple activities of daily living[…]
This presents a problem for simple activities of daily living such as dressing and feeding and certainly has been a limitation with respect to her interaction with grandchildren. She has required a number of modifications to her home such as ergonomic aids in the kitchen and bathroom. • …functional limitations
[…] there has been a rather large psychological impact as well […] • including psycho-emotional sequelae
5. Summarize history post-event Mrs […]'s visits to the office as of late have been for routine issues including another respiratory tract infection as well as more recently some dizziness for which a neurologist was consulted but to my knowledge no serious diagnosis was entertained and an MRI of the head was reported as normal.
6. Opinion Certainly it is clear to me that Mrs […]'s level of functioning has been quite profoundly affected by this accident and its resultant chronic pain.
7. Current status and management • dx • further tests & tx
7. Current status and management • dx • further tests & tx • anticipated benefit of further tx
7. Current status and management • dx • further tests & tx • anticipated benefit of further tx • prognosis
8. Answer critical questions • current level of function?
8. Answer critical questions • current level of function? • level of function pre-event?