Cross-Examining Psych Doctors-Tip #24-Incomplete Disorders

When you see that a doctor has diagnosed a Major Depressive Disorder, check to see if the diagnosis is complete.  The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM) indicates that in order to diagnose any form of a Major Depressive Disorder correctly it is necessary to specify whether the disorder has been of the Single Episode or the Recurrent variety and also to specify the severity of the disorder.  In fact, the DSM indicates that not only must the doctor verbally describe these factors but they must also provide numerical diagnostic codes to unambiguously identify the specific Major Depressive Disorder they wish to diagnose.  When you see that the doctor has provided an incomplete Major Depressive Disorder, you should ask them where in their report they provided the information about their diagnosis as required by the DSM and of course, you should always make sure that the doctor has provided enough information in their report to indicate that all of the diagnostic criteria were satisfied.

Check out my blog (http://drleckart.blogspot.com).  More help can be found at my website (www.drleckartwetc.com) and in my book Psychological Evaluations In Litigation: A Practical Guide for Attorneys and Insurance Adjusters

MMPI Test Score Validation Service for Attorneys and Adjusters

          

The Minnesota Multiphasic Personality Inventory (MMPI) is the gold standard of psychological testing.  The MMPI is well known as a valid and reliable measure of psychopathology.  It is also highly capable of detecting an individual’s credibility, including whether they are trying to depict themselves in an unrealistically favorable light or trying to appear to have symptoms that do not exist.  MMPI scores are normally presented in every medical-legal psych report.  However, experience has shown that a large number of those scores are simply not possible for the patient to get, demonstrating that the doctor has made an error in scoring and/or reporting the scores.  Until now the only way to get that information has been to go to the testing manual or one of the many books on the MMPI.  

Here’s the deal!  If you are an attorney or an adjuster that has a medical-legal psych report and you want to know if the scores in the doctor’s report are possible, email me the report or the pages with the scores and I will provide you with a work-product privileged report that will tell you whether those scores are possible or if the doctor has made a fatal error.

Just a convenient and free way of establishing the credibility of the doctor’s data!

More help can be found at my website (www.drleckartwetc.com) and in my book Psychological Evaluations In Litigation: A Practical Guide for Attorneys and Insurance Adjusters

Cross-Examining Psych Doctors-Tip #23-Persistence in Questioning

Cross examinations of doctors work best with a series of simple questions that mostly can be answered either “yes” or “no” that will expose all the flaws in the doctor’s report.  An attorney should always pay attention when the doctor goes off the “deep end” and gives a long-winded discussion that contains unresponsive answers, incomprehensible jargon or “word salad.”  This is a sign that the doctor is backed up against a wall.  When this occurs the attorney should just go back to their original simple question and keep asking it until the doctor provides a clear answer.

More help can be found at my website (www.drleckartwetc.com) and in my book Psychological Evaluations In Litigation: A Practical Guide for Attorneys and Insurance Adjusters

Cross-Examining Psych Doctors-Tip #22-Stick to Questioning the Report

A common mistake made by attorneys when cross-examining a psych doctor is asking questions about the patient.  The only relevant information is the content of the doctor’s report.  Unfortunately, if the attorney asks about the patient, the doctor is free to provide information that is not in their report that may justify their conclusions.  Obviously, that information may be correct for a variety of reasons. However, if the attorney confines their questions to the contents of the report no “new evidence” can find its way into the testimony. More help can be found at my website (www.drleckartwetc.com) and in my book Psychological Evaluations In Litigation: A Practical Guide for Attorneys and Insurance Adjusters

Cross-Examining Psych Doctors - Tip #21-The Review of Medical Records

The patient’s medical records can speak volumes about an examinee’s credibility, can be used in conducting an examination, and may be valuable in drawing conclusions about a psychiatric injury and/or in apportioning psychiatric disability.  Attorneys should examine the doctor’s review of medical records to determine if they cited any documents that support their diagnosis.  When there are no such records from a mental health practitioner that is one less data source bolstering the doctor’s final conclusions.More help can be found at my website (www.drleckartwetc.com) and in my book Psychological Evaluations In Litigation:  A Practical Guide for Attorneys and Insurance Adjusters

Missing Data? Get an Apricot™!

Are you an attorney who has gotten an “awful” psych report on a personal injury or workers’ compensation case? Did the doctor simply not find anything wrong with the patient because he or she did not look carefully? Do you know if the data needed for a complete psychological evaluation were absent from the doctor’s report? If so, not all is lost, get an Apricot™ that will provide you with all of the information and questions to ask the doctor that will expose all the report’s flaws during the doctor’s deposition. Essentially, an Apricot™ describes the psych report’s flaws in jargon-free, non-technical language; discusses specific techniques used to Cx the doctors; and provides multiple questions that get those flaws on the record despite what might be the doctor’s non-cooperative behavior.   You can also write your own Apricot™ with the self-help resources at my website, DrLeckartWETC.com. 

Did the doctor “give away the store?”

Are you an attorney or an insurance adjuster who has gotten an “awful” psych report on a personal injury or workers’ compensation case? Did the doctor “give away the store?” If so, not all is lost, get an Apricot™ that will provide you with all of the information and questions to ask the doctor that will expose all the report’s flaws during the doctor’s deposition. Essentially, an Apricot™ describes the psych report’s flaws in jargon-free, non-technical language; discusses specific techniques used to Cx the doctors; and provides multiple questions that get those flaws on the record despite what might be the doctor’s non-cooperative behavior.   You can also write your own Apricot™ with the self-help resources at my website, DrLeckartWETC.com. 

Clinical Depression

Everybody gets depressed.  However, it is only when that depression is not normal, reasonable, understandable and expectable that it crosses the border and becomes a disorder.  There are many psychological disorders in the DSM-IV-TR that include signs and symptoms of a clinical depression.  Thus, if you are interested in the litigation of psychological claims it is important to know how depression is observable during a psychological evaluation and what to look for in a psych report to see if the author “gave away the store.”

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Cross-Examining Psych Doctors, Tip #20-Measuring Patient Credibility

The first responsibility of any medical-legal evaluator is to determine the patient’s credibility.  Most psychological tests do not have validity scales capable of measuring truthfulness and therefore are useless in medical-legal examinations.  Keeping that in mind, the first step in preparing to Cx a psych doctor is to evaluate the psychological testing data to determine if the doctor has used the appropriate tests and the data show the patient was being honest during the examination. More help can be found at my website (www.drleckartwetc.com) and in my book Psychological Evaluations In Litigation: A Practical Guide for Attorneys and Insurance Adjusters

The End of AMEs?

At the recent California Applicants’ Attorney Association convention in Rancho Mirage some relatively highly placed officials at two very large self-insured employers were overheard agreeing that they were moving away from using AMEs towards a greater use of PQMEs.

So I got to think, “Why is this happening?”

The answer that seems to make the most sense is a proliferation of relatively large defense-oriented medical-legal businesses that contract with multiple QMEs who travel to various locations to conduct examinations. The net result seems to be that there are now more defense-oriented than applicant-oriented QMEs. Most importantly, as we shall see, from a statistical point of view even when there is only a relatively small majority of defense-oriented QMEs that difference can have a huge impact on the system.

Read More: http://drleckartwetc.com/wp-content/uploads/2016/04/CALIFORNIA-NEWSLETTER-ISSUE-2-FINAL.pdf

Cross-Examining Psych Doctors - Tip #19-The Mental Status Examination (MSE)

A Mental Status Examination (MSE) produces a set of observations made by the doctor during a face-to-face meeting. An MSE should contain a description of the patient’s appearance and social behavior, observations about the patient’s credibility, statements made by the patient indicative of any possible psychopathology, observations of mood or affect, and measurements of the patient’s memory, concentration, insight, and judgment.  Without MSE data supporting the doctor’s diagnosis the report falls by the wayside.

More help can be found at my website (www.drleckartwetc.com) and in my book Psychological Evaluations In Litigation: A Practical Guide for Attorneys and Insurance Adjusters

Cross-Examining Psych Doctors, Tip #18-Check Out The Doctor's History

One of the first steps in reviewing a psych report is seeing if the doctor took a complete history of the patient’s symptoms or complaints to indicate that their diagnosis is correct. The history section is only complete once the doctor has sufficient data about each symptom's qualitative nature, including its frequency, intensity, duration, onset and course over time.

 More help can be found at my website (www.drleckartwetc.com) and in my book Psychological Evaluations In Litigation: A Practical Guide for Attorneys and Insurance Adjusters