Cross Examining Psych Doctors - Tip #49-The Correct Diagnostic Procedure for Discussing the Global Assessment of Functioning

The Global Assessment of Functioning (GAF) scale is found in the DSM-IV-TR, but was eliminated from the largely discredited and ignored DSM-5.  When assigning a GAF score the doctor is required by DSM-IV-TR protocol to provide both the current GAF score and the highest GAF score the patient achieved in the previous 12 months.  If the doctor has not done so they have left out some important and required information about the patient.

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Cross Examining Psych Doctors - Tip #48-One Thing Never to Ask a Doctor During a Depo or Trial

In cross-examining a doctor it is never a good idea to ask a question about the patient!  It is strongly recommended that all the questions you ask be directed at the doctor’s report or other medical records.  For example, instead of asking the doctor to describe what they observed that led them to conclude that the patient was suffering from a disorder they diagnosed, it is much better to ask them where in their report or their treatment notes you can find the data indicating that they made sufficient observations of the patient to warrant their diagnosis.  The reason for this is quite simple.  If you ask the doctor about the patient they can feel free to provide information not in their records that may justify some of their conclusions.  Obviously, those comments may or may not be correct for a variety of reasons. 

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Cross Examining Psych Doctors - Tip #47-Collateral Sources of Information in Psych Reports

Collateral sources of information are found in the form of interview data collected from friends, relatives and/or co-workers or business associates of a patient undergoing a medical-legal examination.  However, only rarely are collateral sources of information available and used in evaluations for the court.  Most typically this occurs when there is some barrier to collecting data such as might occur with a person who is developmentally disabled, deceased, or who might be unable to communicate if, for example, they have suffered a severe cerebral stroke or other mentally debilitating central nervous system 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

Cross Examining Psych Doctors - Tip #46-The Team Approach to Medical-Legal Evaluations

Medical-legal reports signed by the appointed physician may also be signed by a second or third physician who participated in the evaluation’s procedures. If the law has intended to have a single physician conduct a medical-legal evaluation, the use of the “team approach” may constitute a violation of the law and by itself question the substantiality and admissibility of the doctors’ report.  At the very least, the “team approach” makes it difficult to decide who to contact and who to depose in the event that there is some ambiguity in the evaluative report.

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

Helpful Information for Cross-Examining Psych Doctors

In all medical-legal psych cases after all the adversarial posturing is done one can only hope that some semblance of the truth was revealed.  Regardless of which side of these litigations you take, there are things you can do to enhance your position.  Specifically, whether the evaluating or treating doctor has diagnosed a disorder you don’t believe is present, or whether they failed to diagnose a condition you believe the patient has, you can take effective action.  Over time I have provided readers of my newsletters with various tips on how to cross-examine psych doctors.  This newsletter reviews some of those tips.

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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 #45-Biofeedback

Biofeedback requires the use of biomechanical electronic transducers for measuring physical processes, which the individual tries to modify in order to achieve some psychotherapeutic effect.  It should be noted that biofeedback therapists are “certified” by private organizations such as the Biofeedback Society of California and the Biofeedback Certification Institute of America.  All biofeedback training has four common features.  First, in all biofeedback procedures the subject or patient is made aware of various physiological functions that they normally might not be conscious of, such as their heart rate or brainwaves.  Second, this awareness is produced by using various electronic instruments that provide measures of the activity of those systems.  Third, those measurements are provided as information or feedback to the subject or patient either visually, auditorily, or possibly in the tactile modality.  Fourth, the patient is instructed, asked to, or taught to control those functions under the assumption that gaining that control will alleviate psychological symptoms.  If all of these conditions have not been met then the patient has not received psychotherapeutic biofeedback training. 

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Cross Examining Psych Doctors - Tip #44-Psychological Testing Reports

Psychological testing reports are generally written by a psychologist and provide only psychological test results and interpretations that can be used in arriving at conclusions about the patient’s mental status.  Typically, these reports are written at the request of a psychiatrist, who for one reason or another does not feel comfortable or competent to administer and/or interpret the results of psychological testing.  In addition to taking a history, administering a Mental Status Examination and reading the patient’s medical records these psychiatrists refer the patient for testing to provide them with objective information about the patient’s psychological status.  Essentially, it is the responsibility of the psychologist to use valid and reliable tests; administer, score and interpret the tests in a standardized fashion; determine if the patient took the tests in a credible manner; and draw conclusions about the patient consistent with the psychological testing literature published in peer-reviewed journals.  If the psychologist has not done these four things their report is flawed and incapable of providing any meaningful psychological information about the patient. 

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 #43-Malingering

In every medical-legal case the first responsibility of every examiner is to determine the examinee’s credibility.  Sometimes that credibility is simply not there and it is appropriate to diagnose Malingering (V65.2).  Malingering is specified correctly when an individual has intentionally produced false or grossly exaggerated signs and/or symptoms of a physical and/or psychological nature, and that deliberate misrepresentation is motivated by external incentives such as obtaining financial compensation, avoiding work, or evading military duty.  According to the DSM-IV-TR, Malingering should be strongly suspected if there is a combination of any of the following: 

A.     An attorney refers the individual for an evaluation and/or treatment.
B.     There is a marked discrepancy between the individual’s claimed stress or disability and the objective findings.
C.     There is a lack of cooperation with the evaluator’s procedures and/or the treatment prescribed.
D.     The individual presents with an Antisocial Personality Disorder.

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