Cross Examining Psych Doctors - Tip #51-Sadness and Crying are Normal and Not Necessarily Indicative of Psychopathology

In reading medical-legal reports one frequently finds that physicians will list complaints and observations of the patient that are made during the face-to-face interview that include sadness and tearfulness.  In this regard, it should be noted that a reading of page 355 of the DSM-IV-TR and page 168 of the DSM-5 reveals that those manuals explicitly state that, “periods of sadness are inherent aspects of the human experience.” As such, any observations of sadness and related behaviors are not necessarily indicative of psychopathology.  Clearly, while it may be tempting to equate sadness, tearfulness and crying with psychopathology, it should be noted that these behaviors are well within the realm of normal human behavior and not necessarily indicative of pathology.  Individuals may cry for a variety of reasons, including being reasonably, normally, understandably, and expectably upset by physical difficulties, occupational problems and life circumstances. 

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. 

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

Help With Understanding Psych Reports - A Totally Free Lunch

Here's a reference book to help you better understand the weaknesses in psych reports and to prepare for psych depositions and submit briefs to the court.  It is an alternative to commissioning an Apricot.

Download it for free!

The next time you want to know something about a diagnosis, a psych test or a Mental Status Examination just look it up.  Keep in mind that the weakest part of every psych report is the doctor's diagnosis.

Bruce Leckart, Ph.D.

ProfessorEmeritus of Psychology

San Diego State University

(844) 444-8898

www.drleckartwetc.com

Cross Examining Psych Doctors - Tip #38- The Wahler Physical Symptoms Inventory

The Wahler Physical Symptoms Inventory often appears in a psychological test battery of medical-legal evaluators in psychology and psychiatry.  In this regard, the Wahler is a self-report inventory in which the individual is asked to state how frequently they have a variety of physical symptoms or complaints such as "headaches, difficulty sleeping and backaches."  Unfortunately, a reading of the testing manual indicates that there are no validity scales for this instrument (Wahler, H. J., Wahler Physical Symptoms Inventory Manual, Los Angeles:  Western Psychological Services, 1983).  Accordingly, there is no way of detecting individuals who are endorsing complaints that do not exist.  In the absence of test results from the evaluator's battery that establish that the patient completed the testing in an honest and forthright manner, no conclusions can be drawn from the Wahler Physical Symptoms Inventory.  Additionally, the use of this test in a medical-legal examination is inappropriate as the presentation of the test items can be an encouragement to claim symptoms or complaints that do not exist.

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 #23-Persistence in Questioning

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

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

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

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

Did the doctor “give away the store?”

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

Clinical Depression

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

Read more
See more from Dr. Leckart

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

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

The End of AMEs?

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

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

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

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

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

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

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

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

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

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

Cross-Examining Psych Doctors, Tip #17-DSM-IV-TR vs. DSM-5

Although the most recent version of the American Psychiatric Association’s diagnostic manual is the DSM-5, it has been soundly rejected by an overwhelming number of mental health professionals, including Dr. Allen Frances, the former chairperson of the DSM-IV and DSM-IV-TR Task Force, and Dr. Thomas Insel, the Director of the National Institute of Mental Health for over a decade.  Dr. Insel has openly stated that the weakness of the DSM-5 is “its lack of validity.” Thus, The Center for Medicare and Medicaid Services (CMS) along with tens of thousands of mental health professionals have decided to use the DSM-IV-TR or have made “other arrangements.”

More help in cross-examining psych doctors 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