tag:blogger.com,1999:blog-85025083653569328462024-02-07T18:09:58.538-08:00The Med-Legal Psych Professor blogDr. Bruce Leckarthttp://www.blogger.com/profile/17592465630287353242noreply@blogger.comBlogger156125tag:blogger.com,1999:blog-8502508365356932846.post-11193231790872375932021-10-04T10:52:00.000-07:002021-10-04T10:52:03.624-07:00Understanding The Source of Weak Psych Reports<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgsBRo5TG0a8PhVoCFHaOg_YOkUqaOXUA7S8ekIr3M-S5azdQZrHCnlawDBi8IDGwjeQ3xhf94O4rNPMfnRPvD7EjqwrKIA8MuhiC9BW2N7-yRtEYiJC0pDrWAQsGyz1J_0IZaFxKfv7OE/s249/Screen+Shot+2021-10-04+at+10.46.43+AM.png" imageanchor="1" style="font-weight: 700; margin-left: 1em; margin-right: 1em; text-align: center;"><img border="0" data-original-height="108" data-original-width="249" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgsBRo5TG0a8PhVoCFHaOg_YOkUqaOXUA7S8ekIr3M-S5azdQZrHCnlawDBi8IDGwjeQ3xhf94O4rNPMfnRPvD7EjqwrKIA8MuhiC9BW2N7-yRtEYiJC0pDrWAQsGyz1J_0IZaFxKfv7OE/s16000/Screen+Shot+2021-10-04+at+10.46.43+AM.png" /></a></div><p style="text-align: center;"><span> </span><b><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiff9yN2cyLgw4j2n8EWOJe7HpcRuwKcpCceC-b09uDTnWH3AXY0FOorGsvhXoBMF6BmpvBTF_f9PBhu34ieyfODSxsL0WTWCL_HYB-qdS_UywmB-0STU6UXF0hXSow8l8ciysJeQMO7K4/s836/Screen+Shot+2021-10-04+at+10.47.33+AM.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="398" data-original-width="836" height="163" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiff9yN2cyLgw4j2n8EWOJe7HpcRuwKcpCceC-b09uDTnWH3AXY0FOorGsvhXoBMF6BmpvBTF_f9PBhu34ieyfODSxsL0WTWCL_HYB-qdS_UywmB-0STU6UXF0hXSow8l8ciysJeQMO7K4/w320-h163/Screen+Shot+2021-10-04+at+10.47.33+AM.png" width="320" /></a></b></p><p> <u>If you’re an attorney or an adjuster in workers’
compensation or personal injury, general liability, or
any jurisdiction where a psych doctor produces a report
of their evaluation or treatment in response to the claim
of a mental injury, you are always confronted with
psych reports that are weak. But do you understand
them and do you know how to defeat them? Let me help
you do both! This month I’ll tell you how to understand
them. In the next two months, I’ll tell you how to beat
them.</u></p><p><span> </span>Many of you who have referred workers’
compensation and personal injury cases to me over the
last three-plus decades know that I have evaluated
between 5,000 and 10,000 applicants and plaintiffs. As
part of my practice, I’ve read tens of thousands of psych
reports, the vast majority of which are demonstrably
substantially flawed.</p><p><span> </span>First, a little of my professional history will help to
understand what I think is going on. For the first 30
years after getting my Ph.D. I was a full-time college
professor. As part of my job I did a lot of research and
widely published my findings in a variety of subject
areas and carefully edited professional journals. As a
“publish or perish” academic, journal editors would not
let me, or anyone else, get away with authoring any
conclusions without adequately supporting those
comments with hard, cold data describing what I did
and what I found. But in the medical-legal arena there
are no journal editors to keep forensic psychiatrists,
psychologists, and/or neuropsychologists on their toes.
They can write anything they want and often what they
write is nonsense. Worse yet, unless those doctors are
correctly confronted to defend their conclusions, their
reports stand, to the detriment of almost everyone and every entity in the system, except the reporting
physicians.</p><p><span> </span>Before I started doing forensic work I was
amazed when an orthopedist friend showed me some
psych reports from his cases. I simply could not
believe the weakness of those documents. In fact,
what drew me to forensic psychology was the
immediate perception I could write better reports
standing on my head and could demolish what was
passing as professional work and maybe make a
positive contribution to the field. In the many years
since, nothing has changed except the doctor’s
names.</p><p><span> </span>It hurts me to say this, but the vast majority of
psych reports are substantially flawed, grossly
lacking in credibility and completely incapable of
proving or disproving a disputed medical fact or a
contested claim. The questions that are always with
me is, <b>“Why Are There So Many Substantially
Flawed Psych Reports?” And, “What Can Be
Done to Defeat Them?” </b>So, this month, I set out to
see if I could answer those questions!</p><p><span> </span>One possible reason I see such bad reports is
because the attorneys and adjusters who refer cases
to me know I am a demanding critic who does not
shy away from “crushing” bad reports, but who loves
to do so. According to this explanation, I see a biased
sample of incompetent reports because attorneys
know a bad report when they see it but because they
don’t quite know how to reveal the flaws on cross-examination they send it to me for help. I doubt it,
but according to this theory most of the reports are
not worthless, only the ones I get to see.</p><p><span> </span>A second possible reason I see bad reports is
despite having gone through medical or graduate
school, an internship and a residency, some psychiatrists and psychologists, and maybe those that
are most likely to work in a forensic practice, are simply
doing what they were taught. Simply put, they have
never been trained to conduct competent evaluations
and write competent reports. Despite all the many hours
spent on their education they were left lacking the basic
“non-rocket science” ability to perform competent
psychological assessments and write proficient reports. I
can’t talk about psychiatric training from firsthand
experience but I know that with very rare exceptions,
graduate school, internships and postdoctoral training in
psychology does not teach competent evaluations and
report writing.</p><p><span> </span>A third possibility is that incompetent reports are the
result of forensic practitioners never having to suffer the
consequences of their poor work, hence they never learn
to correct their methods. Here, the major culprit is the
legal system. Specifically, attorney’s understandable
lack of knowledge of psychology and psychiatry leads
them to unsuccessfully challenge the doctor’s reports,
which, in turn, results in the doctors never learning to
improve.</p><p><span> </span>A fourth possibility is that the doctors simply do not
care if their work is below par since they continue to get
paid for bad work. Although these doctors read my
critiques and/or encounter them in giving testimony
they follow their same flawed evaluative procedures and
report formats because it’s just easier to write off a
single bad case outcome than change their methods. Or,
maybe they just rationalize the bad outcomes and tell
themselves, “What does that attorney/judge/jury know
about my area? I did a good job. They just don’t
understand what I do.” The bottom line here is that
whatever intervenes between being called on the carpet
and the next report is completely ignored. The
appropriate analogy is if you feed pigeons in the park
they’ll keep coming back for more. Unfortunate for
justice!</p><p><span> </span>QUESTION: WHY IS ALL OF THIS
HAPPENING? </p><p><span> </span>ANSWER: THE PHILOSOPHICAL DIFFERENCE
BETWEEN EVIDENCE-BASED PRACTICE (EBP)AND “CURRENT GUT-ORIENTED/FEELING
BASED STANDARDS.”</p><p><span> </span>Evidence-based psychological and psychiatric
practice is making decisions about the diagnosis, cause,
and treatment of psychopathology that is based on
academically grounded scientific research. Evidence-based psychological and psychiatric practitioners rely
on objective evidence in drawing evaluative
conclusions. In contrast, non-evidence-based
practitioners rely on their “gut,” intuition, clinical
judgment or subjective feelings about what is
occurring. </p><p><span> </span>Nowhere can the contrast be more clearly seen than
in the American Psychiatric Association’s <u>Diagnostic
and Statistical Manual of Mental Disorders-Fifth
Edition</u>, the DSM-5! </p><p><span> </span>I have written extensively about the DSM-5 and
how in the workers’ compensation arena in California
it does not conform to Labor Code section 3208.3
which wisely requires that psychological diagnoses be
made using a diagnostic manual “generally approved
and accepted nationally by practitioners in the field of
psychiatric medicine.” </p><p><span> </span>Fortunately, the DSM-5 has not been widely
accepted either nationally or internationally. If you
want documentation about the reasons I can suggest
you read a series of newsletters I published in the latter
part of 2013 and in the beginning of 2014 at my
website, drleckartwetc.com. </p><p><span> </span>Perhaps the single most telling weakness of the
DSM-5 occurs in the attitude it expresses concerning
the criteria it has written for the literally thousands of
disorders found in that diagnostic manual. </p><p><span> </span>Specifically, the DSM-5, which supposedly
represents the official view of mental disorders for the
psychiatric community states very clearly and
concisely on page 25: </p><p><span> </span>“it is important to note that the
definition of mental disorder included in
DSM-5 was developed to meet the needs of clinicians, public health
professionals, and research
investigators rather than all of the
technical needs of the courts and legal
professionals.” </p><p> <span> </span>This statement follows on the heels of what was
said on page 21: </p><p><span> </span>“Diagnostic criteria are offered as guidelines
for making diagnoses, and their use should be
informed by clinical judgment.” </p><p><span> </span>WELL NOW WHAT DO THOSE STATEMENTS
TELL US? </p><p> <u> </u><u>BY EMPLOYING THE SIMPLE WORD
“GUIDELINES” THEY TELL US THAT THE
CRITERIA LAID OUT FOR THOUSANDS OF
PSYCHOLOGICAL DISORDERS IN THE 947-
PAGE DSM-5 CAN BE COMPLETELY IGNORED
BY DIAGNOSING PSYCHOLOGISTS AND
PSYCHIATRISTS, AND ESPECIALLY THOSE
WORKING IN FORENSICS IN FAVOR OF THEIR
CLINICAL JUDGMENT! </u></p><p><span> </span>OR, IF YOU PREFER, “DEAR FORENSIC
PRACTITIONERS: PLEASE FEEL
COMFORTABLE TO COMPLETELY IGNORE THE
EVIDENCE-BASED KNOWLEDGE OF THE 1810
MENTAL HEALTH PROFESSIONALS, LISTED
ON PAGES 897-916, WHO CONTRIBUTED TO
THE DSM-5 DIAGNOSES AND JUST USE YOUR
GUT FEELINGS, INTUITIONS OR CLINICAL
JUDGMENT IN DRAWING THE CONCLUSIONS
IN YOUR FORENSIC REPORTS AND IN
PROVIDING TESTIMONY IN COURT!” </p><p><span> </span>AND YOU WONDER WHY YOU SEE SUCH
TERRIBLY DOCUMENTED REPORTS WITH
SUCH UNSUPPORTED CONCLUSIONS AND
RECOMMENDATIONS? </p><p><span> </span>At this point, I’m pretty sure you know that for the
last 10 years I have been writing Apricots™. An
Apricot™ is a work-product privileged report written
for an insurance adjuster and/or an attorney who
believes they have a substantially flawed
psychological or psychiatric report that will harm their client’s case. In my Apricots™ I find and describe
those flaws in non-technical language and discuss the
specific techniques and strategy for cross-examining
the doctor, providing simple questions designed to
expose those flaws during a deposition or trial despite
a slippery doctor’s evasiveness. Those same
Apricots™ are frequently used to write trial briefs or
appeals. You can simply think of me as “the
watchdog,” a nickname given to me by an attorney
who has successfully used my Apricots™ on multiple
occasions.</p><p><span> </span>This had been the hardest newsletter I have
written over the last 10+ years. In fact, I have
struggled for some time about whether or not I should
write this newsletter, thinking that maybe I’ve missed
something and that incompetence is not the main
issue. Well, maybe I have made that mistake and
someone will shortly send me proof.</p><p><span> </span>Finally, I also know this newsletter is going to
anger a lot of my colleagues, but then I think, “Maybe
they should write better reports.”</p><p><b>Now for some good news! If you are an attorney or
an insurance adjuster or supervisor and you just
know you have a substantially flawed psych
report, send it to me for a free phone consultation
describing the flaws in the report and get a cost
estimate of an Apricot™. </b><b>Just give me a call at 310-444-3154 and we will set up a time to chat.</b></p><p></p>Dr. Bruce Leckarthttp://www.blogger.com/profile/17592465630287353242noreply@blogger.com0tag:blogger.com,1999:blog-8502508365356932846.post-63142287282949144262021-10-04T10:30:00.001-07:002021-10-04T10:30:17.703-07:00The Economics of Dismantling Flawed Psych Reports<p><span></span></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiFEt0G1wfhSEQhVPT8Yma_AC2epC4GuYEwK1Xq94pDcvnwd1G7BlOWrHnudnUjQlOuL2aLWzRCZ62POisgEZFYmeSnSlmGPxRZXLFThTVwkG_hgOlZpK-1eW1yWkvDQ-31T4mZ1siY5mM/s645/Screen+Shot+2021-10-04+at+10.28.02+AM.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="386" data-original-width="645" height="234" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiFEt0G1wfhSEQhVPT8Yma_AC2epC4GuYEwK1Xq94pDcvnwd1G7BlOWrHnudnUjQlOuL2aLWzRCZ62POisgEZFYmeSnSlmGPxRZXLFThTVwkG_hgOlZpK-1eW1yWkvDQ-31T4mZ1siY5mM/w440-h234/Screen+Shot+2021-10-04+at+10.28.02+AM.png" width="440" /></a></div><br /> I’ve been doing personal injury and workers’
compensation psych cases for over thirty years. In
that time I have evaluated about 10,000 claimants.
I’ve also reviewed about 50,000 psych reports. For
the last 12 years, I have written reports and given
testimony that conclusively demonstrates that the
vast majority of the opposing doctor’s reports are
substantially flawed and can be revealed on cross-examination of the doctor to be worthless with
regard to a judge and/or jury drawing a reasonable
conclusion that a claimant has had a psychiatric
injury. As part of what I write in my reports, which
are commissioned to critique the opposing doctor’s
conclusions, I provide attorneys with a specifically
designed line of direct questions that demonstrate to
even the most unsophisticated juror the
worthlessness of the opposing doctor’s opinions.<p></p><p><span> </span>My reports are not inexpensive. A typical report
costs between $6,000 and $10,000, depending on the
number of diagnoses and the number of errors the
doctor made. They usually run about 50-70 pages. In
those pages, the attorneys and adjusters find specific
information about the substantial flaws in the
opposing doctor’s report. Nowhere in my reports do
I present any unsupported summary conclusions.
Everything I say is documented and backed up with
the appropriate citations from the extensive
published peer-reviewed psychological and
psychiatric literature dating back to the 1800’s. Not
only am I a renegade crusader in pursuing my
fraternity brothers and sorority sisters in forensic
psychology and psychiatry who “mess up,” I’m also a student of the game, and a Professor Emeritus of
Psychology who at one time was the youngest full
professor of psychology in the United States. If
there is a forensic psychologist with my academic
background I’ve never heard of them.</p><p><span> </span>So now I want you to consider the logic behind
spending between $6,000 and $10,000 to dismantle
or destroy another doctor’s testimony. The bottom
line here is that if a plaintiff’s or applicant’s attorney
presents a six to eight-figure settlement demand, and
I have worked on some very large cases, my fee is
miniscule provided I can do what I say. So what is it
that I do? What is the logic or rationale behind my
reports?</p><p><span> </span>Essentially, the major problem with
psychological and psychiatric reports is
misdiagnosis. Once an attorney can demonstrate that
there is no support for the doctor’s diagnosis all of
the conclusions about a compensable mental injury
get thrown out the proverbial window. Well, how is
that done?</p><p><span> </span>The current accepted standard for psychological
diagnoses is the DSM-IV-TR, the American
Psychiatric Association’s Diagnostic and Statistical
Manual, Fourth Edition, Text Revision. A beautiful
book that clearly and directly specifies the signs and
symptoms that must be present in order to draw a
conclusion that the plaintiff is suffering from a
disorder. So where do the doctors fall short?</p><p><span> </span>As I’ve written in innumerable places, including
my book, Psychological Evaluations in Litigation, a
copy of which you can read and or download for free on my website at DrLeckartWETC.com,
psychological diagnoses are based on as many as five
sources of information. </p><p>These sources are:
1. The doctor’s complete history of the patient’s
symptoms or complaints, including information about
their qualitative nature, frequency, intensity, duration,
date of onset and course over time. </p><p>2. The results of the doctor’s Mental Status
Examination, including data obtained from their direct
observations of the patient’s mood, affect, memory,
concentration, insight and judgment. </p><p>3. The findings of an objective psychological testing
battery, including data in the form of specific scores
from a well-known, valid and reliable test such as the
MMPI (Minnesota Multiphasic Personality Inventory),
that show that the patient has been both honest and
credible during the doctor’s examination and in all
reasonable medical probability is suffering from one or
more psychological disorders found in the DSM-IVTR. </p><p>4. and 5. A review of the patient’s medical records and
a presentation of any data that may have been obtained
from the patient’s friends, relatives and/or business
associates supporting the doctor’s conclusions.</p><p><span> </span>Most importantly, I provide a series of specific
questions to ask the doctor, that when answered
demonstrate the opposing doctor’s conclusions are
wrong! Those questions are backed up with cold,
hard data and reasoning that can stand up to any
attempt of the opposing counsel to rehabilitate the
doctor’s typically embarrassing testimony. </p><p><span> </span>Quite simply, it is a rare psychologist or
psychiatrist who has written a report and/or given
deposition or trial testimony that demonstrates the
existence of a psychological disorder as a result of
the claimed injurious occurrence(s). </p><p><span> </span>Compare my $6,000 to $10,000 fee that results
in the opposing doctor’s testimony being shown to
be worthless with the jury and/or judge providing an
award that dwarfs my charge! </p>Dr. Bruce Leckarthttp://www.blogger.com/profile/17592465630287353242noreply@blogger.com0tag:blogger.com,1999:blog-8502508365356932846.post-12100871730799559052021-09-25T11:37:00.000-07:002021-09-25T11:37:02.257-07:00Saving Client Money While Defending Psych Claims<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh7yjv3pfbD72YNSphixFKQXeuOeca3m9lEO8UP38KnUgjCJag8o3EERMD9CvdZ74eDnaoMnRgjvyUVTb41UZVSDrmSxblIwGNCOiE1pnhxw_XeERdGXYD5CVxI-Vjhb9-gPSj6a-_4S5A/s217/Money+1.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="180" data-original-width="217" height="280" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh7yjv3pfbD72YNSphixFKQXeuOeca3m9lEO8UP38KnUgjCJag8o3EERMD9CvdZ74eDnaoMnRgjvyUVTb41UZVSDrmSxblIwGNCOiE1pnhxw_XeERdGXYD5CVxI-Vjhb9-gPSj6a-_4S5A/w460-h280/Money+1.jpg" width="460" /></a></div><p class="p2" style="font-family: "Times New Roman"; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal; margin: 0px;"><span style="font-size: x-small;"><span class="s1" style="font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;"> </span></span></p><p class="p2" style="font-family: "Times New Roman"; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal; margin: 0px;"><span style="font-size: x-small;"> I’ve been doing psych evaluations for litigation for over 30 years. During that time I’ve worked for both the defense and the plaintiffs or applicants. I’ve read and critiqued between 30,000 and 50,000 psych reports but rarely have I seen a report whose conclusions were adequately supported by the data. For the last 12 years, I have been a renegade on a crusade to eliminate substantially flawed reports, being willing to incur the wrath of my colleagues by going into court and testify against other doctors.<span class="Apple-converted-space"> </span></span></p><p class="p2" style="font-family: "Times New Roman"; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal; margin: 0px;"><br /></p><p class="p2" style="font-family: "Times New Roman"; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal; margin: 0px;"><span style="font-size: x-small;"><span class="s1" style="font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;"> </span>As part of my service, I have been writing Apricots<span class="s2" style="font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;">TM </span>to help attorneys win their cases. For reasons I cannot really understand, most of my commissions come from defense attorneys although substantial flaws are equally found in reports commissioned by both sides. Regardless, an Apricot<span class="s2" style="font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;">TM </span>is a work-product privileged report that helps an attorney cross-examine and/or write a trial brief by describing the substantial flaws found in a psych doctor’s report in jargon-free, non-technical language with supporting documentation from the peer-reviewed literature. Apricots™<span class="s2" style="font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;"> </span>also provide attorneys with a series of specific questions to ask the doctor that results in getting those flaws into the record despite the doctor’s evasive or non-cooperative behavior.<span class="Apple-converted-space"> </span></span></p><p class="p2" style="font-family: "Times New Roman"; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal; margin: 0px;"><br /></p><p class="p2" style="font-family: "Times New Roman"; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal; margin: 0px;"><span style="font-size: x-small;"><span class="s1" style="font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;"> </span>One way of saving on the costs of litigation is NOT to hire a doctor to examine the claimant. Let’s see how that might work.<span class="Apple-converted-space"> </span></span></p><p class="p2" style="font-family: "Times New Roman"; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal; margin: 0px;"><br /></p><p class="p2" style="font-family: "Times New Roman"; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal; margin: 0px;"><span style="font-size: xx-small;"> </span><span style="font-size: x-small;">Whether you are on one side or the other there will be times when your opposing counsel will have the claimant examined by a psych doctor. That</span><span class="s1" style="font-size: 12px; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;"> </span><span style="font-size: x-small;">doctor will write a report. One common way of coping with that report is to hire your own doctor to examine the claimant, give deposition testimony and perhaps appear in court to testify about the claimant’s psychological condition. Of course, this is not inexpensive.<span class="Apple-converted-space"> </span></span></p><p class="p2" style="font-family: "Times New Roman"; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal; margin: 0px;"><br /></p><p class="p2" style="font-family: "Times New Roman"; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal; margin: 0px;"><span style="font-size: x-small;"> Another way of dealing with the case is initially to simply deal with the doctor’s reports and records. Considering that the chance is great that the physician’s report is substantially flawed and relatively easily discredited, you can have me write an Apricot<span class="s2" style="font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;">TM </span>and use that document and the questions I provide to discredit the doctor’s testimony during a deposition or at trial. At that point, the opposing counsel will be more amenable to a settlement in your favor and you will have saved the expense of another doctor’s report as well as the associated costs of depositions and trial testimony.<span class="Apple-converted-space"> </span></span></p><p class="p2" style="font-family: "Times New Roman"; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal; margin: 0px;"><br /></p><p class="p2" style="font-family: "Times New Roman"; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal; margin: 0px;"><span style="font-size: x-small;"> Finally, I would like to suggest to you that if you have a report that you suspect is substantially flawed you can send me a copy and I’ll tell you all about its flaws in a free telephone consult at 310-444-3154. At that point, you can decide if you want me to write an Apricot™<span class="s2" style="font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;"> </span>or go it alone based on the information I gave you. If you decide on the latter you can go to my website at DrLeckartWETC.com and download a free copy of my book, Psychological Evaluations in<span class="Apple-converted-space"> </span>Litigation: A Practical Guide for Attorneys and Insurance Adjusters and use some other resources found there to plan out your strategy.<span class="Apple-converted-space"> </span></span></p><p class="p2" style="font-family: "Times New Roman"; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal; margin: 0px;"><span style="font-size: x-small;"><br /></span></p><p class="p2" style="font-family: "Times New Roman"; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal; margin: 0px;"><span style="font-size: x-small;"> Or, you can ask me to write a report that includes a complete analysis of the flaws with<span class="Apple-converted-space"> </span>supporting data and professional literature citations as well as a full set of questions that will dismantle the doctor’s testimony during cross-examination. Either way, I’m here to help.<span class="Apple-converted-space"> </span></span></p>Dr. Bruce Leckarthttp://www.blogger.com/profile/17592465630287353242noreply@blogger.com0tag:blogger.com,1999:blog-8502508365356932846.post-1500891282473793232021-09-23T10:23:00.007-07:002021-09-25T11:07:39.839-07:00A Horror Story For Insurance Companies<div class="separator" style="clear: both; text-align: center;"><br /></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhwVz8t2I0TlOB6veCILoR9vHScNL8UYdcY8ZDZhDd2rzO3JRBNH0c5elXtyFMDZAgz50P1wy2XMfqbyGg_3y7XE_yH66qm6pfi1-T0Y9q7F5e-VvvrIyqKfSkzNmfxZgh4CCK2iBpaJzs/s503/Image+for+Blog+newsletter+1120.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="384" data-original-width="503" height="382" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhwVz8t2I0TlOB6veCILoR9vHScNL8UYdcY8ZDZhDd2rzO3JRBNH0c5elXtyFMDZAgz50P1wy2XMfqbyGg_3y7XE_yH66qm6pfi1-T0Y9q7F5e-VvvrIyqKfSkzNmfxZgh4CCK2iBpaJzs/w642-h382/Image+for+Blog+newsletter+1120.png" width="642" /></a></div><br /><div class="separator" style="clear: both; text-align: center;"><br /></div><p style="background-color: white; font-family: Arial, sans-serif; font-size: 14pt; margin: 0px; padding: 0px;"><span style="background-color: transparent; font-family: "Times New Roman", serif; font-size: 12pt;"> John Jones gets injured. For this horror story, it doesn’t matter if he was at work or shopping in a supermarket. It doesn’t even matter how the claimed injury occurred or even if he was really injured.</span></p><p style="background-color: white; font-family: Arial, sans-serif; font-size: 14pt; margin: 0px; padding: 0px;"><span id="yiv8216641960email_12" style="font-family: "Times New Roman", serif; font-size: 12pt;">John gets a lawyer to represent his interests. For the sake of discussion, let’s assume the lawyer files the claim saying the injury was psychological or psychiatric. The lawyer then sends John to a psychologist or a psychiatrist for an evaluation and treatment. The doctor writes a report stating that John had an injury. He begins treatment. The insurance company representing the defendant sends John to another doctor for an opinion. That doctor doesn’t completely concur with John’s lawyer’s doctor but agrees that John was psychologically injured.</span></p><p style="background-color: white; font-family: Arial, sans-serif; font-size: 14pt; margin: 0px; padding: 0px;"><span style="font-family: "Times New Roman", serif; font-size: 16px;"><br /></span></p><p style="background-color: white; font-family: Arial, sans-serif; font-size: 14pt; margin: 0px; padding: 0px;"><span style="font-family: "Times New Roman", serif; font-size: 16px;"> At some later time in the claims process the insurance company pays John some money to compensate him for his injury. John, his lawyer, the insurance company, the defense’s lawyer and both doctors are all happy with the settlement. John has been paid for his damages, the doctors and lawyers have been paid for their services, and the insurance company has paid what they believe is a reasonable amount of money.</span></p><p style="background-color: white; font-family: Arial, sans-serif; font-size: 14pt; margin: 0px; padding: 0px;"><span style="font-family: "Times New Roman", serif; font-size: 16px; text-decoration-line: underline;"><br /></span></p><p style="background-color: white; font-family: Arial, sans-serif; font-size: 14pt; margin: 0px; padding: 0px;"><span id="yiv8216641960email_13" style="font-family: "Times New Roman", serif; font-size: 16px;"> </span><span style="font-family: "Times New Roman", serif; font-size: 16px; text-decoration-line: underline;">Everyone wins! Or do they? Who loses</span><span style="font-family: "Times New Roman", serif; font-size: 16px;">? Just imagine for a second that the insurance company’s doctor made a mistake in their evaluation. Let’s make it a big mistake, although the size hardly matters. Let’s assume John has successfully exaggerated his injury, or worse yet, faked it entirely. Now there is a loser! No, it’s not the insurance company! They don’t lose because they pass the cost of the claim onto their clients. Every time the insurance company pays out an exaggerated or fraudulent claim the policyholders unjustly pay!</span></p><p style="background-color: white; font-family: Arial, sans-serif; font-size: 14pt; margin: 0px; padding: 0px;"><span style="font-family: "Times New Roman", serif; font-size: 16px;"><br /></span></p><p style="background-color: white; font-family: Arial, sans-serif; font-size: 14pt; margin: 0px; padding: 0px;"><span style="font-family: "Times New Roman", serif; font-size: 16px;"> So along comes another law firm who recognizes the unjust consequences of the insurance company’s doctor’s failure to identify what should have been an easily detected exaggerated or faked claim and files a class action lawsuit on behalf of not only John’s claim, but all the claims that were settled based on inadequate defense doctor evaluations. </span><span id="yiv8216641960email_14" style="font-family: "Times New Roman", serif; font-size: 16px; text-decoration-line: underline;">How much will that class action lawsuit cost the insurance company for failure to use due diligence and good faith</span><span style="font-family: "Times New Roman", serif; font-size: 16px;">? </span><span id="yiv8216641960email_15" style="font-family: "Times New Roman", serif; font-size: 16px; text-decoration-line: underline;">How much will that cost the doctor’s malpractice carriers</span><span style="font-family: "Times New Roman", serif; font-size: 16px;">?</span></p><p style="background-color: white; font-family: Arial, sans-serif; font-size: 14pt; margin: 0px; padding: 0px;"><span style="font-family: "Times New Roman", serif; font-size: 16px;"><br /></span></p><p style="background-color: white; font-family: Arial, sans-serif; font-size: 14pt; margin: 0px; padding: 0px;"><span style="font-family: "Times New Roman", serif; font-size: 16px;"> If you are a defense attorney or a claims adjuster and have what you suspect is a flawed report on your hands, but are not a highly skilled psychiatrist or psychologist, you can prevent making a serious error in judgment and exposing yourself to litigation by getting my analysis of that report. If you’re the defendant in a lawsuit, or represent the defendant who is facing a large loss, settlement and/or increase in their insurance premiums, you can avoid additional costly litigation, including a class action lawsuit by all the insured who have had their premiums wrongly increased as a result of a failure to detect a grossly exaggerated or faked claim by getting an evaluation of the suspected flawed report BEFORE settling the case.</span></p><p style="background-color: white; font-family: Arial, sans-serif; font-size: 14pt; margin: 0px; padding: 0px;"><span style="font-family: "Times New Roman", serif; font-size: 16px;"><br /></span></p><p style="background-color: white; font-family: Arial, sans-serif; font-size: 14pt; margin: 0px; padding: 0px;"><span id="yiv8216641960email_17" style="font-family: "Times New Roman", serif; font-size: 12pt;"> As regular readers of my monthly newsletter know, </span><span id="yiv8216641960email_18" style="font-family: "Times New Roman", serif; font-size: 12pt;">I am a Professor Emeritus of Psychology at San Diego State University who has been doing psychological evaluations for over thirty years. During that time I have brought rigorous academic standards to the practice of forensic psychology. In addition to evaluating claims for both claimants and the defense I have specialized in evaluating the credibility of psychiatric and psychological reports. Having read and critiqued between 10,000 and 50,000 reports, in the true fashion of a renegade crusader, on multiple occasions I have fearlessly stepped up and testified that the vast majority are demonstrably substantially flawed to the point of lacking the ability to prove the doctors’ conclusions.</span></p><p style="background-color: white; font-family: Arial, sans-serif; font-size: 14pt; margin: 0px; padding: 0px;"><span style="font-family: "Times New Roman", serif; font-size: 12pt;"><br /></span></p><p style="background-color: white; font-family: Arial, sans-serif; font-size: 14pt; margin: 0px; padding: 0px;"><span style="font-family: "Times New Roman", serif; font-size: 16px;"> Additionally, I would like to point out that I have been writing what I call Apricots™ for the last 12 years. An Apricot™ is a work-product privileged report that helps an attorney cross-examine and/or write a trial brief by describing the substantial flaws found in a psych doctor’s report in jargon-free, non-technical language with supporting documentation from the peer-reviewed literature. Apricots™ also provide attorneys with a series of specific questions to ask the doctor that results in getting those flaws into the record despite the doctor’s evasive or non-cooperative behavior.</span></p><p style="background-color: white; font-family: Arial, sans-serif; font-size: 14pt; margin: 0px; padding: 0px;"><span style="font-family: "Times New Roman", serif; font-size: 16px;"><br /></span></p><p style="background-color: white; margin: 0px; padding: 0px;"><span style="font-family: Times New Roman, serif;"><span style="font-size: 16px;"> Finally, I would like to suggest to you that if you have a case that you suspect is substantially flawed you can send me a copy of that report and I’ll tell you what’s wrong in a free telephone consult at 844-444-8898. At that point you can decide if you want me to write an ApricotTM or go it alone based on the information I gave you. If you decide on the later you can go to my website at DrLeckartWETC.com and download a free copy of my book, Psychological Evaluations in Litigation: A Practical Guide for Attorneys and Insurance Adjusters and use some other resources found there to plan out your strategy. Or, you can ask me to write a report that includes a complete analysis of the flaws with supporting data and professional literature citations as well as a full set of questions that will dismantle the doctor’s testimony during cross-examination. Either way, I’m here to help.</span></span></p><p style="background-color: white; font-family: Arial, sans-serif; font-size: 14pt; margin: 0px; padding: 0px;"><span style="font-family: "Times New Roman", serif; font-size: 16px;"><br /></span></p><p style="background-color: white; font-family: Arial, sans-serif; font-size: 14pt; margin: 0px; padding: 0px;"><span style="font-family: "Times New Roman", serif; font-size: 16px;"><br /></span></p><div class="separator" style="clear: both; text-align: center;"><br /></div><br /><br /><p style="background-color: white; font-family: Arial, sans-serif; font-size: 14pt; margin: 0px; padding: 0px;"><span style="font-family: "Times New Roman", serif; font-size: 16px;"><br /></span></p><p style="background-color: white; font-family: Arial, sans-serif; font-size: 14pt; margin: 0px; padding: 0px;"><span style="font-family: "Times New Roman", serif; font-size: 16px;"> </span></p><br /><p></p><p style="background-color: white; font-family: Arial, sans-serif; font-size: 14pt; margin: 0px; padding: 0px;"><span style="font-family: "Times New Roman", serif; font-size: 16px;"><br /></span></p><p style="background-color: white; font-family: Arial, sans-serif; font-size: 14pt; margin: 0px; padding: 0px;"><span style="font-family: "Times New Roman", serif; font-size: 16px;"><br /></span></p><p style="background-color: white; font-family: Arial, sans-serif; font-size: 14pt; margin: 0px; padding: 0px;"><span style="font-family: "Times New Roman", serif; font-size: 16px;"><br /></span></p>Dr. Bruce Leckarthttp://www.blogger.com/profile/17592465630287353242noreply@blogger.com0tag:blogger.com,1999:blog-8502508365356932846.post-42849849042382232102020-10-27T15:19:00.002-07:002020-10-27T15:19:31.973-07:00Get The Psych Report Dismissed<span id="docs-internal-guid-5eba7ef9-7fff-78fd-1c79-82e52af6d797"><p dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-left: 18pt; margin-top: 0pt; padding: 0pt 0pt 0pt 18pt; text-align: center; text-indent: -18pt;"><span style="color: #303030; font-family: Cambria, serif; font-size: 10pt; font-style: italic; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">In the words of John Henry Wigmore, cross-examination is “beyond any doubt the greatest legal engine ever invented for the discovery of truth.” </span></p><br /><p dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt; text-align: center;"><span style="color: #303030; font-family: Cambria, serif; font-size: 10pt; font-style: italic; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">3 Wigmore, Evidence §1367, p. 27 (2d ed. 1923)</span></p><br /><p dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt;"><span style="color: #303030; font-family: "Times New Roman"; font-size: 12pt; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;"><span class="Apple-tab-span" style="white-space: pre;"> </span></span><span style="font-family: "Times New Roman"; font-size: 12pt; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">Don’t accept a substantially flawed psych report. Get the report dismissed! </span></p><br /><p dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt;"><span style="font-family: "Times New Roman"; font-size: 12pt; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;"><span class="Apple-tab-span" style="white-space: pre;"> </span></span><span style="font-family: "Times New Roman"; font-size: 12pt; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">Unfortunately, psychiatrists, neuropsychologist, and psychologists often write reports for the courts that are substantially flawed. When you get one of those reports, the first hurdle is to figure out if the doctor did a good job in writing their report or if the report contains fatal errors that could warrant the dismissal of that report by the Trier of Fact. This newsletter will discuss five steps to determine if the report is substantially flawed and should be thrown out. </span></p><br /><p dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt;"><span style="font-family: "Times New Roman"; font-size: 12pt; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;"><span class="Apple-tab-span" style="white-space: pre;"> </span></span><span style="font-family: "Times New Roman"; font-size: 12pt; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">Before proceeding to a discussion of the five steps referred to above, it is imperative that the attorney decide to attack the diagnosis, which is invariably the most vulnerable part of the doctor’s report. It is almost never a good idea to attack the doctor’s conclusions about causation, the Global Assessment of Functioning (GAF) score, apportionment, temporary or permanent disability and/or treatment recommendations without first questioning the doctor about their diagnosis. The reason being that those conclusions are left entirely to the doctor’s subjective opinions while the doctor’s </span><span style="font-family: "Times New Roman"; font-size: 12pt; font-variant-east-asian: normal; font-variant-numeric: normal; text-decoration-line: underline; text-decoration-skip-ink: none; vertical-align: baseline; white-space: pre-wrap;">diagnostic conclusions</span><span style="font-family: "Times New Roman"; font-size: 12pt; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;"> are not left to their subjective opinions. Instead, the doctor’s report should contain substantial medical evidence demonstrating the plaintiff or applicant meets the diagnostic criteria for the disorder found in the American Psychiatric Association’s </span><span style="font-family: "Times New Roman"; font-size: 12pt; font-variant-east-asian: normal; font-variant-numeric: normal; text-decoration-line: underline; text-decoration-skip-ink: none; vertical-align: baseline; white-space: pre-wrap;">Diagnostic and Statistical Manual of Mental Disorders</span><span style="font-family: "Times New Roman"; font-size: 12pt; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">. The bottom line is that the attorney should focus their efforts on challenging the doctor’s diagnosis. </span></p><br /><p dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt;"><span style="font-family: "Times New Roman"; font-size: 12pt; font-variant-east-asian: normal; font-variant-numeric: normal; font-weight: 700; vertical-align: baseline; white-space: pre-wrap;">Five steps to determine if the report is substantially flawed and should be thrown out:</span></p><ul style="margin-bottom: 0; margin-top: 0;"><li dir="ltr" style="font-family: Arial; font-size: 14pt; font-variant-east-asian: normal; font-variant-numeric: normal; list-style-type: disc; vertical-align: baseline; white-space: pre;"><p dir="ltr" role="presentation" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 5pt;"><span style="font-family: "Times New Roman"; font-size: 12pt; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">Determine if the doctor cited sufficient history to indicate that the patient reported sufficient current symptoms to diagnose the disorder correctly. Be sure to determine that the history is complete with data about each complaint’s qualitative nature, frequency, intensity, duration, onset and course over time. </span></p></li><li dir="ltr" style="font-family: Arial; font-size: 14pt; font-variant-east-asian: normal; font-variant-numeric: normal; list-style-type: disc; vertical-align: baseline; white-space: pre;"><p dir="ltr" role="presentation" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt;"><span style="font-family: "Times New Roman"; font-size: 12pt; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">Determine if there are sufficient data in the doctor’s report of their Mental Status Examination (MSE) to support their diagnoses. A MSE should contain a description of the patient’s appearance and social behavior during the face-to-face interview, observations that have led the doctor to conclusions about the patient’s credibility, narrative statements made by the patient that shed light on any possible psychopathology, observations about the patient’s mood and affect, as well as a discussion of observations obtained by measurements of the patient’s memory, concentration and attention, insight, and judgment.</span></p></li><li dir="ltr" style="font-family: Arial; font-size: 14pt; font-variant-east-asian: normal; font-variant-numeric: normal; list-style-type: disc; vertical-align: baseline; white-space: pre;"><p dir="ltr" role="presentation" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt;"><span style="font-family: "Times New Roman"; font-size: 12pt; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">Determine if there are psychological testing data consistent with the doctor’s diagnoses. Information about the psychological tests can be found in my book, </span><span style="font-family: "Times New Roman"; font-size: 12pt; font-variant-east-asian: normal; font-variant-numeric: normal; text-decoration-line: underline; text-decoration-skip-ink: none; vertical-align: baseline; white-space: pre-wrap;">Psychological Evaluations in Litigation</span><span style="font-family: "Times New Roman"; font-size: 12pt; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">, which is available for reading or free downloading at my website (www.drleckartwetc.com). In this regard, an inspection of my book will reveal that most psychological tests are not useful in medical-legal examinations because the first responsibility of any medical-legal evaluator is to determine credibility and most tests do not have measures of credibility. </span></p></li><li dir="ltr" style="font-family: Arial; font-size: 14pt; font-variant-east-asian: normal; font-variant-numeric: normal; list-style-type: disc; vertical-align: baseline; white-space: pre;"><p dir="ltr" role="presentation" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt;"><span style="font-family: "Times New Roman"; font-size: 12pt; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">Determine if the doctor cited any medical records from any mental health professional who agreed with their diagnoses and decide if that doctor’s report(s) were credible. </span></p></li><li dir="ltr" style="font-family: Arial; font-size: 14pt; font-variant-east-asian: normal; font-variant-numeric: normal; list-style-type: disc; vertical-align: baseline; white-space: pre;"><p dir="ltr" role="presentation" style="line-height: 1.2; margin-bottom: 5pt; margin-top: 0pt;"><span style="font-family: "Times New Roman"; font-size: 12pt; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">Determine if the doctor’s report provides information obtained from collateral sources such as the plaintiff’s or applicant’s family, friends and/or business associates that are available at the time of the doctor’s examination and that could possibly support their diagnoses.</span></p></li></ul><p dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt; text-indent: 18pt;"><span style="font-family: "Times New Roman"; font-size: 12pt; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">Follow these five steps when reading through the doctor’s report. When you find that the doctor’s report lacks substantial medical evidence to support their diagnoses, you can set your sights on getting the doctor’s report dismissed. One plan of action is to cross-examine the doctor, asking questions that will expose the absence of substantial medical evidence in their report. Another option is to draft a trial brief that discusses the report’s lack of substantial medical evidence to support the doctor’s diagnoses. In both cases, the end result will likely be the dismissal of the doctor’s flawed report!</span></p><br /><p dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt;"><span style="font-family: "Times New Roman"; font-size: 12pt; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;"><span class="Apple-tab-span" style="white-space: pre;"> </span></span><span style="font-family: "Times New Roman"; font-size: 12pt; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">Now, if you are an attorney or an insurance adjuster or supervisor and you suspect you have a substantially flawed psych report, call me for a free analysis and a cost estimate for obtaining an Apricot™. An Apricot™ is a work-product privileged report written for an insurance adjuster and/or an attorney who believes they have a substantially flawed psychiatric, neuropsychological or psychological report that will harm their client’s case. In my Apricots™ I describe all the flaws in non-technical language and discuss the specific techniques and strategy for cross-examining the doctor, providing simple questions designed to expose those flaws during a deposition or trial despite a slippery doctor’s evasiveness. Those same Apricots™ are frequently used to write trial briefs, petitions, and appeals. Call me at 844-444-8898 or email DrLeckartWETC@gmail.com.</span></p><br /></span>Dr. Bruce Leckarthttp://www.blogger.com/profile/17592465630287353242noreply@blogger.com1tag:blogger.com,1999:blog-8502508365356932846.post-59045946685851354852020-02-13T08:26:00.002-08:002020-02-13T08:26:25.480-08:00The DSM-5 and Weak Psych Reports<div class="separator" style="clear: both; text-align: center;">
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<blockquote>
<em>In
the words of John Henry Wigmore, </em></blockquote>
<em>cross-examination is “beyond any doubt
the greatest legal engine ever invented for the discovery of truth.” </em><br />
<br />
<em>3 Wigmore, Evidence §1367, p. 27 (2d ed. 1923)</em><br />
<br />
In last month’s newsletter after laying out a number of theories I
concluded that psychologists and psychiatrists keep writing
substantially flawed reports in workers’ compensation and personal
injury litigation because of incompetence. In this month’s newsletter I
point out that the same “mind set” that produces weak psych reports is
found in the DSM-5, reinforcing the notion that it’s ok to do bad work.<br />
<br />
Specifically,
both the problematic DSM-5 and the incompetence rampant in forensic
psych is the result of the philosophical difference between
evidence-based practice (EBP) and the “gut-oriented/feeling–based”
standards utilized by many forensic and clinical psych practitioners.<br />
<u>Evidence-based
practice requires making decisions about the diagnosis, cause, and
treatment of psychopathology that is based on academically grounded
scientific research. Evidence-based practitioners rely on objective data
to draw evaluative conclusions. In contrast, non-evidence-based
practitioners rely on their “gut,” intuition, clinical judgment or
subjective feelings</u>.<br />
<br />
Nowhere can the contrast be more clearly seen than in the <u>American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition</u>, the DSM-5!<br />
<br />
I have written extensively about the DSM-5 and how in California’s
workers’ compensation system it does not conform to Labor Code section
3208.3, which wisely requires that psychological diagnoses be made using
a diagnostic manual “generally approved and accepted nationally by
practitioners in the field of psychiatric medicine.” <br />
<br />
There is no doubt that the DSM-5 has been widely <u>rejected</u>
nationally and internationally. If you want documentation about the
reasons, I suggest you read the newsletters I published between June,
2013 and February, 2014, available at my website,
www.DrLeckartWETC.com. <br />
<br />
Perhaps the single most
telling weakness of the DSM-5 occurs in the collective attitude
expressed by its almost 2,000 authors concerning the diagnostic criteria
for the literally thousands of disorders found in that manual.<br />
Specifically, the DSM-5, which attempts to represent the official view
of mental disorders for the mental health community, states very clearly
and concisely on page 21:<br />
<br />
“Diagnostic criteria are offered as guidelines for making diagnoses, and their use should be informed by clinical judgment.”<br />
<br />
A statement follows this on page 25 that reads:<br />
<br />
“it
is important to note that the definition of mental disorder included in
DSM-5 was developed to meet the needs of clinicians, public health
professionals, and research investigators rather than all of the
technical needs of the courts and legal professionals.”<br />
<br />
Well now, what do those statements tell us?<br />
By employing the simple word “guidelines,” the DSM-5 explicitly states
that the criteria laid out for the thousands of disorders in the
947-page DSM-5 can be completely ignored by diagnosticians, especially
those working in forensics, in favor of their “clinical judgment.” <br />
<br />
Or, if you prefer,<br />
<br />
Dear forensic practitioners:<br />
<br />
“Please
feel comfortable and completely free to ignore the evidence-based
knowledge of the 1,810 mental health professionals, listed on pages
897-916 who contributed to the DSM-5 diagnostic criteria. Throw those
criteria out the window, and just use your “gut,” intuitions, clinical
judgment and subjective feelings in drawing diagnostic conclusions and
providing testimony in court!”<br />
<br />
And you wonder why you see such terrible, undocumented reports with unsupported conclusions and recommendations?<br />
<br />
<strong><u>Now
for some good news. For over 30 years I have been fighting incompetent
reports in the course of my multifaceted forensic practice. For the last
10 years I’ve been focused on writing Apricots™. An Apricot™ is a
work product privileged report that lists all of a psych report’s flaws,
explains why they are flaws in jargon-free language, provides published
references supporting my conclusions, and includes simple questions to
ask the psych doctor on Cx that expose the flaws in their
report. Apricots™ are also used to prepare briefs, petitions and/or
appeals. If you are an attorney, an insurance adjuster or supervisor and
you suspect you have a substantially flawed psych report, send it to me
for a free telephone analysis and cost estimate of an Apricot™. You can
reach me at 844-444-8898 and/or </u></strong><a href="http://mailto:DrLeckartWETC@gmail.com/" rel="nofollow noopener" target="_blank"><strong><u>DrLeckartWETC@gmail.com</u></strong></a><strong><u>.</u></strong></div>
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<br />Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-8502508365356932846.post-76678741577751331262020-02-07T09:11:00.003-08:002020-02-07T09:11:44.202-08:00How lawyers can effectively cross-examine psychiatrists and psychologists<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEid0aNbHf3xLrxDnNdJ2UD6ItT7lOxJCRLtoZfL-mUJgiwCwOWWuYZ2QBlwTkQ4mVrd3n7rXkv1rjIKcZvk0DL9AT7sVeUfRk-ePMEpIzylJxyiDH1cFQfX3RIGVSkYUVKwJQ7NUNYEamg/s1600/0717PADVOCACY.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="225" data-original-width="450" height="160" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEid0aNbHf3xLrxDnNdJ2UD6ItT7lOxJCRLtoZfL-mUJgiwCwOWWuYZ2QBlwTkQ4mVrd3n7rXkv1rjIKcZvk0DL9AT7sVeUfRk-ePMEpIzylJxyiDH1cFQfX3RIGVSkYUVKwJQ7NUNYEamg/s320/0717PADVOCACY.png" width="320" /></a></div>
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<div style="text-align: left;">
<span style="font-size: small;"><span style="color: black; font-family: Times New Roman;"><span>G.M. Filisko's article published in July, 2017 ABA Journal states that psychiatrists and psychologists "</span><em>are among the toughest witnesses to challenge because their testimony can have elements of hearsay as well as subjectivity</em>." </span></span></div>
<span style="font-size: small;">
</span><div style="text-align: left;">
<br /></div>
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<span style="font-size: small;"><span style="font-family: Times New Roman;"><span><span style="color: black;">Filisko further states, <em>"Bruce
Leckart, a Los Angeles-based forensic psychologist and professor
emeritus of psychology at San Diego State University, has developed a
set of rules for cross-examining mental health professionals. One rule
is to never ask them about the patient directly but instead confine
questions to their report. Another is to always determine whether they
have taken a complete history of the patient’s symptoms and complaints
to support the diagnosis." </em></span></span></span></span></div>
<div style="text-align: left;">
<br /></div>
<span style="font-size: small;">
</span><div style="text-align: left;">
<span style="font-size: small;"><span style="font-family: Times New Roman;">Read the full article here: <a href="http://trk.cp20.com/click/hzq3d-bdkknk-y7q1ti4/" id="yiv5518628451auto_assign_link_num_10" name="abajournalcommagazinearticlecrossexaminepsych" rel="noopener noreferrer" target="_blank">http://www.abajournal.com/magazine/article/cross_examine_psychiatrists_psychologists</a><br />
</span></span></div>
<span style="font-size: small;">
</span><div style="text-align: left;">
<br /></div>
Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-8502508365356932846.post-76550621942822936042019-07-23T09:45:00.002-07:002019-07-23T09:45:31.554-07:00Trashing Flawed Psych Reports
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEinn74ibA9LOEEhj7clBG4LsYkqpDDIk7I638d6HkDFiqAxGQbAxhwRDywm9DsxHRYapRBeHq5HtfJu3SW6iOX6MR6SIWfBhv_TBjrOY5GFscHdYWOVXCgKjo6_QM3SLyJ6XGtkLQm_syY/s1600/shutterstock_681068053-2-800x600.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="600" data-original-width="800" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEinn74ibA9LOEEhj7clBG4LsYkqpDDIk7I638d6HkDFiqAxGQbAxhwRDywm9DsxHRYapRBeHq5HtfJu3SW6iOX6MR6SIWfBhv_TBjrOY5GFscHdYWOVXCgKjo6_QM3SLyJ6XGtkLQm_syY/s320/shutterstock_681068053-2-800x600.jpg" width="320" /></a></div>
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<i style="mso-bidi-font-style: normal;"><span style="color: #303030; font-family: Cambria; font-size: 10.0pt; mso-bidi-font-family: Arial;">In the words of John Henry Wigmore, cross-examination is
“beyond any doubt the greatest legal engine ever invented for the discovery of
truth.” </span></i></div>
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<br /></div>
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<i style="mso-bidi-font-style: normal;"><span style="color: #303030; font-family: Cambria; font-size: 10.0pt; mso-bidi-font-family: Arial;">3 Wigmore, Evidence §1367, p. 27 (2d ed. 1923)</span></i><span class="cx-content"><i style="mso-bidi-font-style: normal;"><span style="font-family: Cambria; font-size: 10.0pt; mso-bidi-font-family: Arial;"></span></i></span></div>
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<br /></div>
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<span style="color: black; font-family: "Times New Roman"; mso-bidi-font-family: Arial;">The Problem: You’ve got a psych case in which a doctor
diagnosed a disorder and concluded that the patient has had a psychiatric
injury and is psychiatrically disabled. You also have lots of collateral
information indicating that none of this is true. </span></div>
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<br /></div>
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<span style="color: black; font-family: "Times New Roman"; mso-bidi-font-family: Arial;">How do you cross-examine the doctor?</span></div>
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<span style="color: black; font-family: "Times New Roman"; mso-bidi-font-family: Arial;"><br />
If you’re an attorney working on a psych case there is only one way to trash an
unsubstantial or incompetent report. When you take the doctor’s
deposition or trial testimony you attack the doctor’s DSM diagnosis by showing
that their report doesn’t support their diagnosis. </span></div>
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<br /></div>
<span style="color: black; font-family: "Times New Roman"; font-size: 12.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Arial; mso-bidi-language: AR-SA; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-US; mso-no-proof: yes;">If
the diagnostic manual’s criteria are not supported by the data in the doctor’s
report, the doctor’s</span><br />
<span style="color: black; font-family: "Times New Roman"; font-size: 12.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Arial; mso-bidi-language: AR-SA; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-US; mso-no-proof: yes;">diagnosis and all the conclusions flowing from that
diagnosis are worthless. </span><br />
<br />
<br />
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<span style="color: black; font-family: "Times New Roman"; mso-bidi-font-family: Arial;">If you take any other approach the doctor will simply hide
behind their “professional opinion.” Quite simply, all other approaches
or strategies may produce piddling results but will not produce a prideful,
winning outcome.</span></div>
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<br /></div>
<div class="MsoNormal">
<span style="color: black; font-family: "Times New Roman"; mso-bidi-font-family: Arial;">I’ve been singing the same song for over thirty years of
critiquing tens of thousands of psych reports. The only thing that
consistently works is attacking the doctor’s</span><span style="color: black; font-family: "Times New Roman"; font-size: 11.0pt; mso-bidi-font-family: Arial;"> </span><span style="color: black; font-family: "Times New Roman"; mso-bidi-font-family: Arial;">diagnosis.</span></div>
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<br /></div>
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<span style="color: black; font-family: "Times New Roman"; mso-bidi-font-family: Arial;">You want to know how to do that? Ask me! </span></div>
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<span style="color: black; font-family: "Times New Roman"; mso-bidi-font-family: Arial;">(844) 444-8898. No charge for the phone call.</span></div>
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<br /></div>
<span style="color: black; font-family: "Times New Roman"; font-size: 12.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Arial; mso-bidi-language: AR-SA; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-US; mso-no-proof: yes;">End
of the story.</span>
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</style>Dr. Bruce Leckarthttp://www.blogger.com/profile/17592465630287353242noreply@blogger.com0tag:blogger.com,1999:blog-8502508365356932846.post-68126405002220195172018-09-25T08:48:00.001-07:002018-09-25T08:48:33.723-07:00Five reasons to never depose a psych doctor without an Apricot™ - Cross Examining Psych Doctors, Tip #122<div class="separator" style="clear: both; text-align: center;">
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<br /><br />An Apricot™ is a report that provides attorneys and insurance adjusters with information about the flaws in a psych report. An Apricot™ is written on an expert witness basis and is protected by the work product doctrine.<br /><br />1. Attorneys are experts in the law and typically not experts in psychology or psychiatry.<br />2. Psych doctors have the upper hand when being deposed by an attorney.<br />3. An Apricot™ uses non-technical terms to describe the flaws in a psych report revealing that the report does not constitute substantial medical evidence.<br />4. An Apricot™ provides the attorney with a list of simple questions to use on cross-examination of the doctor.<br />5. An Apricot™ provides a list of the major problems in the doctor’s report.<br />Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-8502508365356932846.post-2345405436554980532018-08-31T09:42:00.000-07:002018-08-31T09:42:23.102-07:00When psych reports are not in your favor - What to do about it - Tip #121<br />
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Dr. Bruce Leckart conducts psychological evaluations in workers’
compensation and personal injury litigation. In addition to evaluating
patients, he provides Apricots™ for attorneys and insurance adjusters
who have a psych report not in their favor. An Apricot™ is a
work-product privileged report used to assist an attorney in
cross-examining a doctor and/or writing a trial brief for the court.
Essentially, Dr. Leckart will find every flaw in the report, write up
those flaws in easy-to-understand terms and provide the attorney with a
list of simple questions to use in cross-examination. It doesn’t matter
which state you are located in or the jurisdiction, Dr. Leckart can
assist when you have a psych report that is not in your favor.
<br />
<br />
Give us a call today: (844) 444-8898Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-8502508365356932846.post-69017693141072965532018-07-03T08:41:00.001-07:002018-07-03T08:41:15.218-07:00The Miller Forensic Assessment of Symptoms Test (M-FAST) - Cross-Examining Psych Doctors, Tip #120
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhvPb87mrrHFqkYcXx7WW4iZ4WMzFnUkPwULLeBMPKHClXWSuZ4UTzumGT0fGv3o1duJC0vmufgKz2y1d5o8SliCWno_1t-qMxbNDoPah4lY1WGpciv3xBFZ42tk_7Vfq6y-oMmlTWBZJk/s1600/Forensic-Psychology.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1197" data-original-width="1600" height="239" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhvPb87mrrHFqkYcXx7WW4iZ4WMzFnUkPwULLeBMPKHClXWSuZ4UTzumGT0fGv3o1duJC0vmufgKz2y1d5o8SliCWno_1t-qMxbNDoPah4lY1WGpciv3xBFZ42tk_7Vfq6y-oMmlTWBZJk/s320/Forensic-Psychology.jpg" width="320" /></a></div>
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<span style="font-family: "Courier New"; mso-bidi-font-family: "Courier New"; mso-bidi-font-size: 13.0pt;"><span style="mso-tab-count: 1;"> </span>The
M-FAST is a 25-item, doctor-administered, brief structured interview designed
to identify individuals who may be over-reporting, exaggerating, or fabricating
psychological symptoms.<span style="mso-spacerun: yes;"> </span>However, the
M-Fast is not a psychological test in the sense that it presents any physical
material that is administered to a patient.<span style="mso-spacerun: yes;">
</span>Clearly, the results of the M-Fast are based on the doctor’s subjective
observations, rather than the patient’s objective responses and therefore, this
measure is not capable of presenting any non-interview objective data to the
court.<span style="mso-spacerun: yes;"> </span>When you find that the doctor
discussed the M-Fast in their report you should ask the doctor if the M-Fast
has any demonstrably effective methods for measuring the individual’s
test-taking attitudes and credibility.</span></div>
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</style>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-8502508365356932846.post-76445420927279244472018-07-03T08:39:00.001-07:002018-07-03T08:39:16.159-07:00The MMPI K Scale - Cross-Examining Psych Doctors, Tip #119
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<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi3TVcDJjuroUXa7pZ5OWGbswZG_qASuMXk1EmvT73Onll39IjiseQ9X0FznunJ-04Bu-IeFdgfwvG21y8HXN8aDGWAVhK6jb2aMpv-9Hheimwb3TuUIREvlsqn89m1aEIHfrqBoa1ZLgA/s1600/k+picture.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="225" data-original-width="225" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi3TVcDJjuroUXa7pZ5OWGbswZG_qASuMXk1EmvT73Onll39IjiseQ9X0FznunJ-04Bu-IeFdgfwvG21y8HXN8aDGWAVhK6jb2aMpv-9Hheimwb3TuUIREvlsqn89m1aEIHfrqBoa1ZLgA/s1600/k+picture.png" /></a></div>
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<span style="font-family: "Courier New"; mso-bidi-font-family: "Courier New"; mso-bidi-font-size: 13.0pt; mso-fareast-font-family: "Times New Roman";"><br /></span></div>
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<br /></div>
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<span style="font-family: "Courier New"; mso-bidi-font-family: "Courier New"; mso-bidi-font-size: 13.0pt; mso-fareast-font-family: "Times New Roman";"><span style="mso-tab-count: 1;"> </span>The Minnesota Multiphasic Personality
Inventory (MMPI) is a psychological test that is considered the gold standard
of test batteries used in medical legal evaluations.<span style="mso-spacerun: yes;"> </span>The MMPI-2 was published in 1989 and has many
proponents who depend on the test’s validity scales to provide information
about the individual’s test-taking attitudes and credibility.<span style="mso-spacerun: yes;"> </span>In fact, the MMPI-2 is the most commonly used
version of the MMPI by psychologists and psychiatrists.<span style="mso-spacerun: yes;"> </span>Every validity and clinical scale performance
is described with a T-Score on the MMPI-2 which all have a mean of 50 and a
standard deviation of 10.<span style="mso-spacerun: yes;"> </span>Further, it is
well known and universally accepted that T-Scores of 65 or larger are
clinically significant or interpretable.<span style="mso-spacerun: yes;">
</span>In this regard, the K Scale is one of the validity scales of the
MMPI-2.<span style="mso-spacerun: yes;"> </span>T-Scores 65 or higher on the K
Scale are </span><span style="font-family: "Courier New"; mso-bidi-font-family: "Courier New"; mso-bidi-font-size: 13.0pt;">associated with the exaggeration of
physical disability</span><span style="font-family: "Courier New"; mso-bidi-font-family: "Courier New"; mso-bidi-font-size: 13.0pt; mso-fareast-font-family: "Times New Roman";"> and </span><span style="font-family: "Courier New"; mso-bidi-font-family: "Courier New"; mso-bidi-font-size: 13.0pt;">distorting the individual’s
true psychological condition.</span></div>
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</style>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-8502508365356932846.post-37974636704854763672018-06-28T08:34:00.002-07:002018-06-28T08:34:44.729-07:00Proverbs in a Mental Status Examination - Cross-Examining Psych Doctors, Tip #118
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<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjrfBNtX2q65SEzFlU6S_bxdpkXDetv2iR5Hhpt2MCjvVhIBY1wPaNGmBZRrZcXQjg82ENfwrsY58HCDyHgsflvg8PAotylwYktbziiXFU9dMnk_Ja-aaonTObdBL-3VkGaXKUYnX5CooA/s1600/_83555492_cartoon-549.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="351" data-original-width="624" height="179" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjrfBNtX2q65SEzFlU6S_bxdpkXDetv2iR5Hhpt2MCjvVhIBY1wPaNGmBZRrZcXQjg82ENfwrsY58HCDyHgsflvg8PAotylwYktbziiXFU9dMnk_Ja-aaonTObdBL-3VkGaXKUYnX5CooA/s320/_83555492_cartoon-549.jpg" width="320" /></a></div>
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<span style="font-family: "Courier New"; mso-bidi-font-family: "Courier New"; mso-bidi-font-size: 13.0pt;"><br /></span></div>
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<br /></div>
<span style="font-family: "Courier New"; font-size: 12.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: "Courier New"; mso-bidi-font-size: 13.0pt; mso-bidi-language: AR-SA; mso-fareast-font-family: "MS Mincho"; mso-fareast-language: EN-US; mso-no-proof: yes;"><span style="mso-tab-count: 1;"> </span>One of the five
basic sources of information that compose a credible psychological or
psychiatric examination and report is a Mental Status Examination.<span style="mso-spacerun: yes;"> </span>A Mental Status Examination is normally part
of every face-to-face clinical interview during a medical legal
evaluation.<span style="mso-spacerun: yes;"> </span>In this regard, a Mental
Status Examination produces a set of observations of the patient that are made
by the doctor under reasonably controlled conditions, employing a relatively
standard set of examining techniques and questions.<span style="mso-spacerun: yes;"> </span>One of those examining techniques is to ask
the examinee to interpret a set of proverbs.<span style="mso-spacerun: yes;">
</span>For example, insight can be measured by asking the patient to interpret
proverbs such as “a stitch in time saves nine.”<span style="mso-spacerun: yes;">
</span>Similarly, judgment can be measured by simply asking the person what
they would do if they found a child locked in a car on a hot summer’s day.<span style="mso-spacerun: yes;"> </span>When reading a psych report you may notice
that the doctor commented on the patient’s insight and/or judgment but did not
provide any easily and normally obtainable observational data concerning those
processes.<span style="mso-spacerun: yes;"> </span>Accordingly, during a
deposition an attorney should ask the doctor where in their report they cited
their Mental Status Examination test results supporting their conclusions about
the patient’s judgment and insight.</span>
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</style>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-8502508365356932846.post-12191215952433722018-05-24T09:49:00.001-07:002018-05-24T09:49:15.794-07:00Serial 3s Task - Cross-Examining Psych Doctors, Tip #117
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiE1N-U0Z-8vqxV8Z5Q6JrVb7JmQtC2rikK9Z0RvZFoIJSiwAes_-fy5Zg3Kfo9AadMvELUV13oDCJb63OhStdMKXRDjhU6bMEScOvHn3iR9LSyXq5wVcTnD8L_UoyzVShOTVqRWxn3-98/s1600/serial+3s.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="422" data-original-width="750" height="180" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiE1N-U0Z-8vqxV8Z5Q6JrVb7JmQtC2rikK9Z0RvZFoIJSiwAes_-fy5Zg3Kfo9AadMvELUV13oDCJb63OhStdMKXRDjhU6bMEScOvHn3iR9LSyXq5wVcTnD8L_UoyzVShOTVqRWxn3-98/s320/serial+3s.jpg" width="320" /></a></div>
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<span style="font-family: "Courier New"; mso-bidi-font-family: "Courier New"; mso-bidi-font-size: 13.0pt;"><span style="mso-tab-count: 1;"> </span>When
performing a Mental Status Examination during a psychological evaluation, the
doctor may choose to have the patient count backward from 20 by 3s as a measure
of their concentration.<span style="mso-spacerun: yes;"> </span>This task is
called a serial 3s task and can be done relatively quickly during a
face-to-face interview.<span style="mso-spacerun: yes;"> </span>The patient’s
performance on a serial 3s task is a measure of concentration.<span style="mso-spacerun: yes;"> </span>When a doctor chooses to use a serial 3s task
to measure the patient’s concentration, it is imperative that they describe
their observational data in their report of their Mental Status Examination.<span style="mso-spacerun: yes;"> </span></span></div>
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</style>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-8502508365356932846.post-3331003912597368912018-04-17T08:56:00.001-07:002018-04-17T08:56:14.595-07:00Serial 7s Task - Cross-Examining Psych Doctors, Tip #116
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj1u3wsqEmfTQeYE1gd3rJc33vwYla5b14MkC3L1EHIcUzSU2ol2QKMACNvrsh-I0WmloNXOwGq-szfTYX4eLZcY9S3uchonftlevpg6Em8NnSWMadjZyNMAbUKRedcqizvJAniwNcmdQk/s1600/mental-math.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="300" data-original-width="300" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj1u3wsqEmfTQeYE1gd3rJc33vwYla5b14MkC3L1EHIcUzSU2ol2QKMACNvrsh-I0WmloNXOwGq-szfTYX4eLZcY9S3uchonftlevpg6Em8NnSWMadjZyNMAbUKRedcqizvJAniwNcmdQk/s1600/mental-math.png" /></a></div>
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<span style="font-family: "Courier New"; mso-bidi-font-family: "Courier New"; mso-bidi-font-size: 13.0pt;"><br /></span></div>
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<br /></div>
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<span style="font-family: "Courier New"; mso-bidi-font-family: "Courier New"; mso-bidi-font-size: 13.0pt; mso-bidi-font-weight: bold;"><span style="mso-tab-count: 1;"> </span>A Mental Status Examination produces a set
of observations of the patient, which are made by the doctor, under reasonably
controlled conditions, employing a relatively standard set of examining
techniques and questions.<span style="mso-spacerun: yes;"> </span>Measuring and
reporting on observational data of the patient’s functioning in the area of
concentration is typically part of every Mental Status Examination report.<span style="mso-spacerun: yes;"> </span></span><span style="font-family: "Courier New"; mso-bidi-font-family: "Courier New"; mso-bidi-font-size: 13.0pt;">For example, one
measure of concentration is to ask an individual to count backwards from 100 by
7s.<span style="mso-spacerun: yes;"> </span>This is known as a serial 7s
task.<span style="mso-spacerun: yes;"> </span>The patient’s performance on this
task is a measure of their concentration and, when administered by the doctor,
the doctor’s observations of the patient’s performance should be described in
their report of their Mental Status Examination.</span></div>
Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-8502508365356932846.post-84498790839783603042018-03-21T08:05:00.001-07:002018-03-21T08:05:26.331-07:00<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgqcoivZ8YdQXlforqKtrM4utoEgrKX1uzCkrg-Ss6_7ius2Qy5ruJxkYiX1etKWEv7cUhLo5n0YM2SoInHeKznaAl6xm6nCfi37AfCw93TDThVjr9Xpvzt0o4t-YjR8DfoUO2F09U0K_U/s1600/lien.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="210" data-original-width="210" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgqcoivZ8YdQXlforqKtrM4utoEgrKX1uzCkrg-Ss6_7ius2Qy5ruJxkYiX1etKWEv7cUhLo5n0YM2SoInHeKznaAl6xm6nCfi37AfCw93TDThVjr9Xpvzt0o4t-YjR8DfoUO2F09U0K_U/s1600/lien.jpg" /></a></div>
<br />
Liens for psychological and psychiatric treatment <br />
can be disputed!<br />
<br />
If an inspection of the data in the psych doctor's report does not support the doctor's diagnosis, the conclusion is inescapable that the doctor's report does not support the doctor's diagnosis warranting the need for mental health treatment. At that point, it is reasonable to conclude that the doctor's liens are not supported by the doctor's report. <br />
<br />
<br />
https://tinyurl.com/ycpxyqtqUnknownnoreply@blogger.com0tag:blogger.com,1999:blog-8502508365356932846.post-68756162356066751342018-01-30T10:49:00.000-08:002018-01-30T10:49:00.476-08:00Dysthymic Disorder - Cross-Examining Psych Doctors, Tip #115
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<span style="font-family: "Courier New"; mso-bidi-font-size: 13.0pt;"><span style="mso-tab-count: 1;"> </span>According to the criteria found in the <u>Diagnostic
and Statistical Manual of Mental Disorders,</u> a Dysthymic Disorder is
diagnosed correctly when the individual presents with a chronically depressed
mood that occurs for most of the day, more days than not, for at least two
years.<span style="mso-spacerun: yes;"> </span>During periods of depressed mood,
at least two of the following additional symptoms are present:<span style="mso-spacerun: yes;"> </span>poor appetite or overeating, insomnia or
hypersomnia, low energy or fatigue, low self-esteem, poor concentration or
difficulty making decisions, and feelings of hopelessness.<span style="mso-spacerun: yes;"> </span>When you find that a psych report lacks
information supporting the diagnosis of a Dysthymic Disorder, the attorney
should ask the doctor, where in their report they provided historical data
demonstrating that the patient met the diagnostic criteria for a Dysthymic
Disorder.</span></div>
Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-8502508365356932846.post-77238114125819542402018-01-30T10:47:00.002-08:002018-01-30T10:47:58.893-08:00A Major Depressive Disorder with Mild Severity - Cross-Examining Psych Doctors, Tip #114<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjRW0k0KCBM2nTaPU8WmX8W0fIvUVB13i1Nzih2R0-AJNFnFDlcRKJo6lBfMkK4JbjaLPjuFBIZKzJU_p7RpkR1vxAPAMDyYGorgNTcFSiZcMvHrdquhXSEj05gwbrJZQ77xkFdbcCs90A/s1600/MDD.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="223" data-original-width="226" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjRW0k0KCBM2nTaPU8WmX8W0fIvUVB13i1Nzih2R0-AJNFnFDlcRKJo6lBfMkK4JbjaLPjuFBIZKzJU_p7RpkR1vxAPAMDyYGorgNTcFSiZcMvHrdquhXSEj05gwbrJZQ77xkFdbcCs90A/s1600/MDD.jpg" /></a></div>
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<span style="font-family: "Courier New"; mso-bidi-font-size: 13.0pt;"><span style="mso-tab-count: 1;"> </span>A Major Depressive Disorder is a severe
Mood Disorder that is characterized by a pervasive clinical depression and a
series of associated symptoms.<span style="mso-spacerun: yes;"> </span>The
severity of a Major Depressive Disorder often mandates that the patient be
given substantial anti-depressant medication, psychotherapy, hospitalization
and possibly electroconvulsive shock therapy.<span style="mso-spacerun: yes;">
</span>According to the criteria for Major Depressive Disorder found in the <u>Diagnostic
and Statistical Manual of Mental Disorders</u>, if the patient presents with
five or six symptoms, the diagnostic modifier “Mild” is used in specifying the
disorder.<span style="mso-spacerun: yes;"> </span>Doctors should be questioned
on cross-examination when you find they do not provide information in their
report supporting their conclusions about the severity of a Major Depressive
Disorder.</span></div>
Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-8502508365356932846.post-61144828677464143642018-01-30T10:46:00.001-08:002018-01-30T10:46:34.736-08:00Neuropsychologists - Cross-Examining Psych Doctors, Tip #113
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<span style="font-family: "Courier New"; mso-bidi-font-size: 13.0pt; mso-fareast-font-family: "Courier New";">Neuropsychologists
have obtained either a Ph.D. or a Psy.D. in psychology and have taken
additional postdoctoral training in the area of neuropsychology.<span style="mso-spacerun: yes;"> </span>Neuropsychologists can provide information
about how a neurological injury may affect and/or be affected by psychological
variables.<span style="mso-spacerun: yes;"> </span>They also can provide
information about whether a patient’s difficulties are likely to be due to
brain pathology or emotional factors.<span style="mso-spacerun: yes;">
</span>Further, neuropsychologists typically administer a relatively large
number of tests, called a battery, in a face-to-face manner.<span style="mso-spacerun: yes;"> </span>Test batteries are sometimes designed by the
neuropsychologist to answer specific questions and at other times standardized
batteries are used.<span style="mso-spacerun: yes;"> </span>In short,
neuropsychologists are psychologists with advanced or postdoctoral training in
evaluating brain functions and correlating specific cognitive and emotional
impairments with specific brain pathology. </span></div>
Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-8502508365356932846.post-14648487411773039842018-01-30T10:44:00.002-08:002018-01-30T10:44:47.614-08:00Panic Attacks - Cross-Examining Psych Doctors, Tip #112
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEghwln4iCKATuFg45d8tlmHfhCRteQCh7CQcOBrlRiz5Y7IwUZVKuKVzx74_v5L8YGLKSIPOCE8ZwtjMW5mlbjDjpmh0iB2bmfST1jjNHxDnYmVPHZS35YqegOKATE6JKb31FQsV9fKkxs/s1600/panic+attack.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="360" data-original-width="480" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEghwln4iCKATuFg45d8tlmHfhCRteQCh7CQcOBrlRiz5Y7IwUZVKuKVzx74_v5L8YGLKSIPOCE8ZwtjMW5mlbjDjpmh0iB2bmfST1jjNHxDnYmVPHZS35YqegOKATE6JKb31FQsV9fKkxs/s320/panic+attack.jpg" width="320" /></a></div>
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<br /></div>
<span style="font-family: Cambria; font-size: 12.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: "Times New Roman"; mso-bidi-font-size: 13.0pt; mso-bidi-language: AR-SA; mso-fareast-font-family: "MS Mincho"; mso-fareast-language: EN-US;">A
Panic Attack is characterized by a discrete period of intense fear or
discomfort in which four or more of 13 symptoms occur that develop abruptly and
reach a peak within ten minutes.<span style="mso-spacerun: yes;"> </span>A Panic
Attack is not a disorder in and of itself.<span style="mso-spacerun: yes;">
</span>When Panic Attacks are followed by one month or more of either
persistent concern about having additional attacks, worry about the
implications of the attacks or the consequences, or a significant change in
behavior related to the attacks, the individual may meet criteria for a Panic
Disorder.</span>
Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-8502508365356932846.post-77115316696708211702018-01-30T10:41:00.001-08:002018-01-30T10:42:10.240-08:00Panic Disorder Without Agoraphobia, Cross-Examining Psych Doctors, Tip #111<style>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhTmRmoPJvDq9O5cVewbSIb88NlqiVB5N_4RSJtRT2rNYuK4V_JTUmm8H9h_k9ol0Wv9auZ9IotvCmuS9i6mNIi5Fm5fVkp1bs1XgbYIraRNeaVc7IaQdNOpm9_SpP4Jjva0AlKUq_ZRS0/s1600/panic+disorder.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="168" data-original-width="300" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhTmRmoPJvDq9O5cVewbSIb88NlqiVB5N_4RSJtRT2rNYuK4V_JTUmm8H9h_k9ol0Wv9auZ9IotvCmuS9i6mNIi5Fm5fVkp1bs1XgbYIraRNeaVc7IaQdNOpm9_SpP4Jjva0AlKUq_ZRS0/s1600/panic+disorder.jpg" /></a></div>
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<span style="font-family: "courier new"; mso-bidi-font-size: 13.0pt;"><span style="mso-tab-count: 1;"> </span>According to the DSM-IV-TR, a Panic
Disorder Without Agoraphobia is diagnosed correctly when the individual
presents with recurrent and unexpected Panic Attacks.<span style="mso-spacerun: yes;"> </span>There must be evidence that shows that these
Panic Attacks have been followed by one month or more of either persistent
concern about having additional attacks, worry about the implications of the
attacks or the consequences, or a significant change in behavior related to the
attacks.<span style="mso-spacerun: yes;"> </span>Further, the patient must not
exhibit Agoraphobia or anxiety about being in places or situations from which
escape might be difficult or embarrassing.<span style="mso-spacerun: yes;">
</span>When a psych report lacks information supporting the DSM-IV-TR diagnosis
of a Panic Disorder Without Agoraphobia, the attorney should ask the doctor,
where in their report they provided historical data demonstrating that the
patient met the diagnostic criteria for a Panic Disorder Without Agoraphobia.<span style="mso-spacerun: yes;"> </span>This line of questioning will clearly reveal
the flawed nature of the doctor’s report.</span></div>
Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-8502508365356932846.post-51642916581932960912017-10-31T09:05:00.001-07:002017-10-31T09:05:24.520-07:00Major Neurocognitive Disorder - Cross-Examining Psych Doctors, Tip #110
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhmzT-eGRfoeKMcr2r7BEWN3i5kglXCHJMX762DFbYeS1YuV9blY9sN2Znz6emeROEU5AuPaNhNwOF3s28CG969Ha4s17kImoWpliVyCJ4ZLSU9EU6Q4tlK7JTX5nE6lV5zUio5K2qx5B8/s1600/MND%25235.jpeg.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="216" data-original-width="208" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhmzT-eGRfoeKMcr2r7BEWN3i5kglXCHJMX762DFbYeS1YuV9blY9sN2Znz6emeROEU5AuPaNhNwOF3s28CG969Ha4s17kImoWpliVyCJ4ZLSU9EU6Q4tlK7JTX5nE6lV5zUio5K2qx5B8/s1600/MND%25235.jpeg.jpg" /></a></div>
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<span style="font-family: "Courier New"; mso-bidi-font-family: "Courier New";">A Major Neurocognitive Disorder is a relatively new disorder
that appears in the DSM-5, which was published in 2013.<span style="mso-spacerun: yes;"> </span>According to a reading of pages 602 to 605 of
the DSM-5, a Major Neurocognitive Disorder is correctly diagnosed when <span style="mso-bidi-font-weight: bold;">the individual presents with a substantial
impairment in cognitive performance that is measured by the examining
physician’s administration of neuropsychological tests or “another quantified
clinical assessment.”<span style="mso-spacerun: yes;"> </span>Thus, when you are
reading a psych report where the examiner diagnosed a Major Neurocognitive
Disorder you should immediately look to see if the examiner discussed the administration
and results of neuropsychological tests or “another quantified clinical
assessment.”<span style="mso-spacerun: yes;"> </span>If you find that the
examiner has declined to discuss any of these measures, you should question the
doctor about their omission on cross-examination.</span></span></div>
Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-8502508365356932846.post-66999836277077877142017-10-31T09:03:00.003-07:002017-10-31T09:03:57.637-07:00Prepare Your Own Apricot™ - Cross-Examining Psych Doctors, Tip #109
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgK38coYJrZoHlvz5bGjfeu8VL0SliL5BDKcEW1ZhP4NDOoaciHJ_MQchDMzFBF4ye4NO4GGWUDBu2gczaqQMCoqiKFwDZQmJeT5yQloRIErXPWbP_5dV0PbYajAIUWj4EQo7po_n9D3RU/s1600/one_apricot_puzzle.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="225" data-original-width="225" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgK38coYJrZoHlvz5bGjfeu8VL0SliL5BDKcEW1ZhP4NDOoaciHJ_MQchDMzFBF4ye4NO4GGWUDBu2gczaqQMCoqiKFwDZQmJeT5yQloRIErXPWbP_5dV0PbYajAIUWj4EQo7po_n9D3RU/s1600/one_apricot_puzzle.jpg" /></a></div>
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<span style="font-family: "Courier New"; mso-bidi-font-family: "Courier New";"><br /></span></div>
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<br /></div>
<span style="font-family: "Courier New"; font-size: 12.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: "Courier New"; mso-bidi-language: AR-SA; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-US; mso-no-proof: yes;">In 2009 I
began to assist attorneys with written pre-deposition/pre-trial consultation
reports.<span style="mso-spacerun: yes;"> </span>I quickly realized that a “pre-deposition/pre-trial
consultation report” is a mouthful, and a simpler, shorter name was
needed.<span style="mso-spacerun: yes;"> </span>I decided to go with
“Apricot™.”<span style="mso-spacerun: yes;"> </span>Apricots™ are work-product
privileged reports designed to help attorneys cross-examine mental health
professionals such as forensic psychologists, forensic psychiatrists,
neuropsychologists, psychotherapists, social workers etc.<span style="mso-spacerun: yes;"> </span>An Apricot™ describes all of the substantial
flaws in a psych report in jargon-free, non-technical language.<span style="mso-spacerun: yes;"> </span>Most importantly, an Apricot™ also provides a
list of simple questions and techniques that will help get those flaws on the
record despite what might be the doctor’s evasive or non-co-operative
behavior.<span style="mso-spacerun: yes;"> </span>In fact, I’ve made all of the
information you need to prepare your own Apricot™ available for free at my <a href="http://drleckartwetc.com/prepare-your-own-apricot">website</a> (<a href="http://drleckartwetc.com/prepare-your-own-apricot">http://drleckartwetc.com/prepare-your-own-apricot</a>).<span style="mso-spacerun: yes;"> </span>Have at it!</span>
Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-8502508365356932846.post-48834253219431917842017-10-24T09:32:00.001-07:002017-10-24T09:32:11.747-07:00Using Multiple Versions of the DSM - Cross-Examining Psych Doctors, Tip #108
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<span style="font-family: "Courier New"; mso-bidi-font-family: "Courier New";">The <u>Diagnostic and Statistical Manual of Mental Disorders</u>-Fourth
Edition (DSM-IV) was published by the American Psychiatric Association in
1994.<span style="mso-spacerun: yes;"> </span>The DSM-IV became obsolete when
the DSM-IV-TR was published in 2000.<span style="mso-spacerun: yes;"> </span>The
“TR” in DSM-IV-TR stands for Text Revision.<span style="mso-spacerun: yes;">
</span>Most recently, in May, 2013, the DSM-5 was published.<span style="mso-spacerun: yes;"> </span>While many of the diagnoses and the
diagnostic criteria for disorders have remained the same with each revision of
the DSM, substantial differences definitely exist between the manuals.<span style="mso-spacerun: yes;"> </span>Typically, many of the substantial
differences are outlined on multiple pages in the later sections of the
manuals.<span style="mso-spacerun: yes;"> </span>M</span><span style="font-family: "Courier New"; mso-bidi-font-family: "Courier New"; mso-fareast-font-family: "Times New Roman";">oreover, when you are reading a psych report, find the area in
the report where the doctor stated which version of the DSM they used in
arriving at their diagnostic conclusions.<span style="mso-spacerun: yes;">
</span></span><span style="font-family: "Courier New"; mso-bidi-font-family: "Courier New";">When
doing so, if it becomes clear that the doctor simultaneously used two different
versions of the DSM in evaluating the patient and producing their report you
should question the doctor about that substantial flaw on cross-examination. </span></div>
Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-8502508365356932846.post-3183189749810297742017-10-24T09:29:00.001-07:002017-10-24T09:29:10.179-07:00Where is the Psychological Test Battery? - Cross-Examining Psych Doctors, Tip #107
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<span style="font-family: "Courier New"; mso-bidi-font-family: "Courier New";">Objective psychological test data is clearly needed in
medical-legal psych reports where the first responsibility of the examiner in
either psychology or psychiatry is determining the credibility of the patient's
complaints and clinical presentation.<span style="mso-spacerun: yes;"> </span>In
this regard, the principal method for assessing that credibility is an objective
psychological test battery containing such instruments as the Minnesota
Multiphasic Personality Inventory (MMPI) and the Cattell Sixteen Personality
Factor Test (16PF) that are capable of generating test scores providing
information both about the patient's credibility and any possible
psychopathology.<span style="mso-spacerun: yes;"> </span>Typically, objective
psychological test scores are the only information collected by an examiner
that is open to public inspection and can be presented to the court in an
objective and generally numerical fashion.<span style="mso-spacerun: yes;">
</span>Therefore, when you come across a psych report and find that the doctor
declined to give any psychological tests, not only is that a clear failure by
the doctor to assess the patient’s credibility, but they should be questioned
about that substantial flaw on cross-examination. </span></div>
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