Tuesday, May 31, 2016

Cross Examining Psych Doctors - Tip #31-The Beck Anxiety Inventory

The Beck Anxiety Inventory is a self-report rating scale on which the individual is asked to use a 4-point rating scale to describe him or herself on 21 items that are assumed to be common symptoms of anxiety. It should be noted that this is a self-report questionnaire that has no validity scales for assessing the individual’s test-taking attitudes or credibility. Since the first responsibility of a medical-legal examiner is to determine the credibility of the individual’s self-report, this test should not be used in a medical-legal context. 

Wednesday, May 25, 2016

Cross Examining Psych Doctors - Tip #30, DSM-IV vs. DSM-IV-TR

For some unknown reason, psych doctors writing medical-legal reports state they have used the DSM-IV.  The fact is that the DSM-IV-TR was published in May, 2000, rendering the DSM-IV obsolete at that time.  Accordingly, the use of the DSM-IV anytime after May, 2000 is a substantial flaw in the doctor’s report.  While many of the diagnostic criteria for disorders found in the DSM-IV-TR are the same as those found in the DSM-IV there are substantial difference in the two diagnostic manuals as summarized on pages 829 through 843 of the DSM-IV-TR.  I mention this in the event that you encounter the argument that the two diagnostic manuals are the same.  In fact, not only are multiple diagnoses different but the discussion of the various disorders are also dissimilar in a multitude of fashions.  For example, not only were a majority of the paragraphs in the DSM-IV revised to provide up-to-date information about the various disorders, information needed to make correct diagnoses, but the instructions for arriving at a GAF score were greatly expanded.  Additional information about the differences between the DSM-IV and the DSM-IV-TR can be found on the American Psychiatric Associations website (http://www.psychiatry.org).  The bottom line here is that the DSM-IV is not an appropriate diagnostic manual to use for reports written after May, 2000.

Friday, May 20, 2016

Cross Examining Psych Doctors - Tip #29-Sleep Problems

Sleep problems are often reported in psych reports as support for a clinical depression, a PTSD or some other form of psychopathology including one of the many Sleep Disorders.  When determining the credibility of a psych report it is necessary to check that report to be sure the doctor has provided a history of the patient’s sleeping behavior at a time prior to their reported injury date that includes data about the number of hours of sleep they were getting per night, the time it normally was taking the patient to fall asleep, a history of any middle of the night awakening, and a history of any early morning awakening.  In the absence of a complete history of the patient’s pre-injury baseline for comparison purposes, there is no support to indicate that the patient’s sleeping behavior at the time of the doctor’s examination had changed due to the patient’s reported injury.

Tuesday, May 17, 2016



Dr. Bruce Leckart
"Find the Truth, Tell the Story"

Westwood Evaluation & Treatment Center                                               
Toll 844-444-8898                      
For viewing online click       here
May 2016
Volume 1, Issue 88
Deposing Psych Claimants:  Exposing Wash-In Reports
     Psych doctors make two kinds of serious errors when writing evaluative reports for the courts.  The first is failing to diagnose a disorder that is present.  The second is diagnosing a disorder that is not there.  Reports with these errors are called “Wash-Outs” and “Wash-Ins,” respectively.
     For a detailed discussion of Wash-Out and Wash-In reports see my Newsletters of March and April, 2014 on my website at www.DrLeckartWETC.com.
     I help attorneys expose Wash-Out and Wash-In reports with ApricotsTM that assist them in cross-examining the doctor.  An Apricot™ describes a psych report’s flaws in jargon-free language, offers specific techniques to Cx the doctor, and provides multiple questions to get those flaws on the record despite the doctor’s non-cooperative behavior. ApricotsTM are work product privileged reports useful in any jurisdiction.  Lots of information about ApricotsTM and self-help techniques for cross-examining doctors are on my website.
     Another opportunity to expose a Wash-Out or Wash-In report occurs when deposing the claimant.
      But, “How does one expose the flaws in a doctor’s report and the weakness in an error-laden case when deposing the claimant?” 
     The essential element for revealing the flaws in a Wash-In report when taking testimony from the claimant is ridiculously simple
     Let’s say that the doctor has diagnosed a Major Depressive Disorder.  The first step is finding the diagnostic criteria in the American Psychiatric Association’s diagnostic manual.  The second and last step is simply to ask the claimant to describe their current symptoms or complaints and see if their responses match the diagnostic criteria.  I have read hundreds, if not thousands of deposition transcripts and I can’t recall this ever having been effectively accomplished. 
     Now, here’s a script for use in taking the claimant’s deposition
     “Mr. Smith, I would like you to provide me with a complete list of your current physical and psychological symptoms or complaints in a specific way I am about to describe.  First, I would like you to understand that by “current” I mean anything that has been physically or psychologically wrong with you in the approximately last 30 days.  Second, I don’t want you to provide me with any details of those symptoms, just a list.  Third, you can provide the list of your complaints in any order.  And fourth, don’t worry about forgetting to put a symptom on the list since we can always add one later.  Is this clear?”
     Once you have obtained a complete list of current symptoms, it is necessary to ask the claimant to describe the symptom as he experiences it as well as its frequency, intensity, duration, onset and course of those symptoms over time.  So for each of the symptoms ask the claimant to estimate how many days a week they have each symptom, how intense each symptom is, how long does each last, when did they first have that complaint, and how has the complaint changed over time since its inception. 
     The only somewhat problematic issue is obtaining information about the intensity of a symptom.  In this regard, the intensity of a symptom has to be subjectively assessed.  This can be done as follows:  “Mr. Smith, with regard to your complaint of ________ I would like you to tell me how big of a problem this is for you on a ten-point scale by picking a number between 1 and 10 where “1” is the least severe problem that could be called a problem and “10” is the most intense problem imaginable.”
     Now once you have obtained that information all you have to do is compare it to the criteria in diagnostic manual and you will know if Mr. Smithcurrently has sufficient symptoms to warrant the doctor’s diagnosis.  If not, at the very least you have eliminated the possibility that the patientcurrently has the disorder. 
     The next step is to address the possibility that Mr. Smith might have had a Major Depressive Disorder at the time of the doctor’s examination.  The script for this is just as easy!
     “Mr. Smith, now I would like you to provide me with a complete list of all of the physical and psychological symptoms or complaints that you had at the time you were examined by Dr. Jones.  As you did with your current symptoms tell me about every symptom you had when you met with Dr. Jones.  Once again, I don’t want you to provide me with any of details of those symptoms just a list.  Is this clear?”
     Once you have established that Mr. Smith is comfortable with the notion that he has provided you with a complete list of symptoms, at the time of Dr. Jones’s examination it is necessary to ask him to describe the symptom as he experienced it as well as its frequency, intensity, duration, onset and course of those symptoms over time to determine if he had a Major Depressive Disorder when examined by Dr. Jones. 
     In short, a suspected Wash-In report can be dealt with when taking a claimant’s deposition by getting a clear history of their symptoms at the time of the deposition and at the time of the doctor’s examination or any other time in the past.  If there are insufficient symptoms to correspond to the diagnostic manual’s criteria, that is strong evidence that the doctor wrote a Wash-In report.  If you’re a defense attorney what more can you want?

This is the eighty-eighth of a series of monthly newsletters aimed at providing information about pre-deposition/pre-trial consultations, psychological evaluations and treatment that may be of interest to attorneys and insurance adjusters working in the areas of workers’ compensation and personal injury.  If you have not received some or all of our past newsletters listed on the next page, and would like copies, send us an email requesting the newsletter(s) that you would like forwarded to you.
"If in reading a psych report you find reason not to trust its credibility you can send it to me for a thorough analysis."

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Friday, May 13, 2016

Cross Examining Psych Doctors - Tip #28-Cry For Help

Psych reports often contain the classic phrase “a cry for help” as an explanation of psychological testing that reveals that the patient was attempting to simulate symptoms or was “faking.”  In this regard it is important to note that the notion of “a cry for help” is simply an explanation or a theory of why an individual might be attempting to simulate symptoms.  It does nothing to change the fact that the individual was attempting to simulate symptoms or “fake.”  Thus, the theory of a “cry for help” is no more tenable than the tongue-in-cheek theory of “a plea for unwarranted economic benefits.” 

Tuesday, May 10, 2016

Cross-Examining Psych Doctors-Tip #26-Creating Psychological Disorders

For some unknown reason, some psych doctors choose to make up their own diagnoses by “creating” modifiers or specifiers.  These doctors take it upon themselves to add modifiers or specifiers where such modifiers or specifiers are not outlined in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM).  The use of modifiers or specifiers created by the doctors results in a situation where their diagnosis is ambiguous as those creations have no generally understood meaning.  When you see a diagnosis in the doctor’s report that does not exist in the DSM, you should ask the doctor where in the DSM you can find the diagnosis they provided in the manner that they verbally described that disorder.  If you’ve done your homework correctly the doctor really doesn’t have an acceptable answer. 
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 (http://drleckartwetc.com/wp-content/uploads/2012/10/FINAL-051311.pdf)

Friday, May 6, 2016

Cross-Examining Psych Doctors-Tip #26-Where Is The MMPI?

The Minnesota Multiphasic Personality Inventory (MMPI) is an instrument that is widely accepted by the psychological community as being capable of assessing psychopathology and an individual’s test-taking attitudes or credibility.  In fact, the MMPI is the cornerstone of virtually every credible forensic psychological testing battery.  When you see that a doctor has declined to administer an MMPI, you should ask them where in their report they provided their explanation for not doing so.

Tuesday, May 3, 2016

Cross-Examining Psych Doctors-Tip #25-Absence of MMPI Scores

The Minnesota Multiphasic Personality Inventory (MMPI) is an instrument that is widely accepted by psychologists and psychiatrists as being capable of measuring any existing psychopathology and an individual’s test-taking attitudes or credibility.  For some unknown reason, many psych doctors choose to omit MMPI scores from their report.  The absence of those scores means that the reader of their report cannot verify the basis for their summary conclusions.  When you see that a psych doctor has declined to provide the patient’s MMPI scores in their report, you should ask them if there is anything in their report that would allow the reader of that document to confirm the conclusions they drew from the patient’s MMPI.