Cross Examining Psych Doctors - Tip #33-Workplace Violence

Violence in the workplace has many faces and is the cause of a very large number of psychiatric claims in the workers’ compensation and personal injury arenas.  In this regard, workplace violence is defined as “physical assaults or threats of assault directed towards employees” whereas aggression is a more general term that is defined as “behavior that is intended to physically or psychologically harm an individual.”  

Research has shown that in any given year, anywhere from 1% to 5% of employees are victims of a physical assault at work, while anywhere from 9% to 70% of employees are the victim of nonphysical aggression in the workplace, such as verbal abuse, emotional abuse, and/or sexual harassment (Barling, J., Dupre, K. E., & Kelloway, E. K. (2009). Predicting workplace aggression and violence. Annual Review of Psychology, 671-692).  Worse yet, according to a 2011 report by the Occupational Safety and Health Administration (OSHA), workplace homicide accounts for 11% of all fatal workplace injuries in the United States.  In fact, the leading cause of workplace death for women in the United States is homicide.  the rates of violence across numerous occupations are highly similar (e.g., LeBlanc, M. M., & Kelloway, E. K. Predictors and outcomes of workplace violence and aggression. Journal of Applied Psychology, 2002, 87, 444-453).  Believe it or not, a coal miner, a police officer and a university professor have approximately the same chance of being physically or non-physically assaulted by a coworker. 

From a risk management point of view, how can individuals be identified who are likely to act out violently?  One obvious recommendation is to avoid hiring individuals who either have a history of acting out or possess characteristics that are associated with behaving violently.  Depending on the employer’s Human Resources budget, it may be reasonable to do background checks on prospective employees or even pay for a pre-employment psychological evaluation.  Another loss-preventative measure is to continually assess employees for their potential to act out and to provide counseling programs for individuals who show characteristics likely to lead to workplace violence, helping them deal with their personal problems without compromising the organization. 

In developing a strategy to reduce workplace violence, it is often cost effective to hire specialists in industrial-organizational psychology.  These individuals can assist any employer in selecting workers who are less likely to perpetrate or to be the “victims” of violence, can set up programs to monitor for the warning signs of aversive events, and are able to provide plans for taking counter measures to defuse situations. 

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

Cross Examining Psych Doctors - Tip #32-Major Depressive Disorder

A Major Depressive Disorder is a serious mood disorder that is characterized by a depressed mood and associated symptoms.  According to the DSM-IV-TR, to diagnose a Major Depressive Disorder correctly, the individual must present with at least five of nine symptoms.  In addition to having at least five of nine symptoms, the patient must present with Symptom 1 and/or Symptom 2.  An inspection of the DSM-IV-TR reveals that the nine symptoms are as follows: 

1. A depressed mood that is present most of the day and every day or nearly every day. 2. A markedly diminished interest or pleasure in all, or almost all, activities most of the day, every day or nearly every day. 3. A significant weight loss or weight gain while not dieting and/or a decrease or increase in appetite every day or nearly every day. 4. Insomnia or hypersomnia every day or nearly every day, which is a lack of restorative sleep or an overabundance of restorative sleep. 5. Psychomotor agitation or retardation, that is, excessive motor activity or a slowing of body movements, respectively, every day or nearly every day. 6. Fatigue or a loss of energy every day or nearly every day. 7. Feelings of worthlessness and/or excessive or inappropriate guilt every day or nearly every day. 8. Diminished ability to think or concentrate or indecisiveness, every day or nearly every day. 9. Recurrent thoughts of death, recurrent suicidal thoughts without a specific plan, or a suicidal attempt, or a specific plan for committing suicide. 

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

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

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

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

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

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

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

Cross Examining Psych Doctors - Tip #29-Sleep Problems

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

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

THE WETC PSYCHOLOGY NEWSLETTER

THE WETC PSYCHOLOGY NEWSLETTER Dr. Bruce Leckart "Find the Truth, Tell the Story" Westwood Evaluation & Treatment Center                                                Toll 844-444-8898                       DrLeckartWETC@gmail.com, www.DrLeckartWETC.com For viewing online click       here May 2016 Volume 1, Issue 88 Deposing Psych Claimants:  Exposing Wash-In Reports      Psych doctors make two kinds of serious errors when writing evaluative reports for the courts.  The first is failing to diagnose a disorder that is present.  The second is diagnosing a disorder that is not there.  Reports with these errors are called “Wash-Outs” and “Wash-Ins,” respectively.      For a detailed discussion of Wash-Out and Wash-In reports see my Newsletters of March and April, 2014 on my website at www.DrLeckartWETC.com.      I help attorneys expose Wash-Out and Wash-In reports with ApricotsTM that assist them in cross-examining the doctor.  An Apricot™ describes a psych report’s flaws in jargon-free language, offers specific techniques to Cx the doctor, and provides multiple questions to get those flaws on the record despite the doctor’s non-cooperative behavior. ApricotsTM are work product privileged reports useful in any jurisdiction.  Lots of information about ApricotsTM and self-help techniques for cross-examining doctors are on my website.      Another opportunity to expose a Wash-Out or Wash-In report occurs when deposing the claimant.       But, “How does one expose the flaws in a doctor’s report and the weakness in an error-laden case when deposing the claimant?”       The essential element for revealing the flaws in a Wash-In report when taking testimony from the claimant is ridiculously simple!       Let’s say that the doctor has diagnosed a Major Depressive Disorder.  The first step is finding the diagnostic criteria in the American Psychiatric Association’s diagnostic manual.  The second and last step is simply to ask the claimant to describe their current symptoms or complaints and see if their responses match the diagnostic criteria.  I have read hundreds, if not thousands of deposition transcripts and I can’t recall this ever having been effectively accomplished.       Now, here’s a script for use in taking the claimant’s deposition.       “Mr. Smith, I would like you to provide me with a complete list of your current physical and psychological symptoms or complaints in a specific way I am about to describe.  First, I would like you to understand that by “current” I mean anything that has been physically or psychologically wrong with you in the approximately last 30 days.  Second, I don’t want you to provide me with any details of those symptoms, just a list.  Third, you can provide the list of your complaints in any order.  And fourth, don’t worry about forgetting to put a symptom on the list since we can always add one later.  Is this clear?”      Once you have obtained a complete list of current symptoms, it is necessary to ask the claimant to describe the symptom as he experiences it as well as its frequency, intensity, duration, onset and course of those symptoms over time.  So for each of the symptoms ask the claimant to estimate how many days a week they have each symptom, how intense each symptom is, how long does each last, when did they first have that complaint, and how has the complaint changed over time since its inception.       The only somewhat problematic issue is obtaining information about the intensity of a symptom.  In this regard, the intensity of a symptom has to be subjectively assessed.  This can be done as follows:  “Mr. Smith, with regard to your complaint of ________ I would like you to tell me how big of a problem this is for you on a ten-point scale by picking a number between 1 and 10 where “1” is the least severe problem that could be called a problem and “10” is the most intense problem imaginable.”      Now once you have obtained that information all you have to do is compare it to the criteria in diagnostic manual and you will know if Mr. Smithcurrently has sufficient symptoms to warrant the doctor’s diagnosis.  If not, at the very least you have eliminated the possibility that the patientcurrently has the disorder.       The next step is to address the possibility that Mr. Smith might have had a Major Depressive Disorder at the time of the doctor’s examination.  The script for this is just as easy!      “Mr. Smith, now I would like you to provide me with a complete list of all of the physical and psychological symptoms or complaints that you had at the time you were examined by Dr. Jones.  As you did with your current symptoms tell me about every symptom you had when you met with Dr. Jones.  Once again, I don’t want you to provide me with any of details of those symptoms just a list.  Is this clear?”      Once you have established that Mr. Smith is comfortable with the notion that he has provided you with a complete list of symptoms, at the time of Dr. Jones’s examination it is necessary to ask him to describe the symptom as he experienced it as well as its frequency, intensity, duration, onset and course of those symptoms over time to determine if he had a Major Depressive Disorder when examined by Dr. Jones.       BASICALLY, IF MR. SMITH HAS BEEN COOPERATIVE YOU HAVE ALL THE DATA YOU NEED TO DETERMINE IF MR. SMITH HAD A MAJOR DEPRESSIVE DISORDER AT THE TIME OF HIS TESTIMONY AND WHEN EXAMINED BY DR. JONES.      In short, a suspected Wash-In report can be dealt with when taking a claimant’s deposition by getting a clear history of their symptoms at the time of the deposition and at the time of the doctor’s examination or any other time in the past.  If there are insufficient symptoms to correspond to the diagnostic manual’s criteria, that is strong evidence that the doctor wrote a Wash-In report.  If you’re a defense attorney what more can you want? ____________________________________________ This is the eighty-eighth of a series of monthly newsletters aimed at providing information about pre-deposition/pre-trial consultations, psychological evaluations and treatment that may be of interest to attorneys and insurance adjusters working in the areas of workers’ compensation and personal injury.  If you have not received some or all of our past newsletters listed on the next page, and would like copies, send us an email requesting the newsletter(s) that you would like forwarded to you. "If in reading a psych report you find reason not to trust its credibility you can send it to me for a thorough analysis." Browse Dr. Leckart's Book www.drleckartWETC.com Are you serious about winning your psych cases? Pre-deposition consults involving reports of a ·QME ·PQME               ·AME ·APQME               ·IME · PTP  (e-mail us atDrLeckartWETC@gmail.com for more information) Stay Connected           Dr. Bruce Leckart | 844-444-8898 | drleckartwetc@gmail.com | http://drleckartwetc.com/ Call today if you are serious about winning your psych cases!