Fifteen Ideas That Can Drive You "Crazy"

Everyone talks to themselves.  Unfortunately, sometimes the things we say to ourselves are less than productive.  In fact, some of our internal dialogues can make us “crazy.”  Here is the first of the “Big Fifteen.”

3. It is important for me to always win.

Fifteen Ideas That Can Drive You "Crazy"

Everyone talks to themselves.  Unfortunately, sometimes the things we say to ourselves are less than productive.  In fact, some of our internal dialogues can make us “crazy.”  Here is the first of the “Big Fifteen.”

2. It is important for me to be perfect

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

Fifteen Ideas That Can Drive You "Crazy"

Everyone talks to themselves.  Unfortunately, sometimes the things we say to ourselves are less than productive.  In fact, some of our internal dialogues can make us “crazy.”  Here is the first of the “Big Fifteen.”

1. It is important that everyone love me.

www.drleckartwetc.com

(844) 444-8898 

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 #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

Tip #16 - Cross-Examining Psych Doctors-The Diagnosis is Crucial

In writing an Apricot™ for use in cross-examining a psych doctor the focus is most often on the diagnosis, which is the major problem found in most psych reports. Doing this is conceptually very simple.  Just match up the diagnostic criteria found in the Diagnostic and Statistical Manual of Mental Disorders (DSM) with the data found in the doctor’s report to see if the report lacks sufficient data to support the diagnosis.  Once it has been demonstrated that the diagnosis is unsupported, there is absolutely no support for the conclusion that the patient has a psychiatric injury, a psychiatric disability or a need for treatment.

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 #15-How to Decide If That Psych Report Is Really As Bad As You Think

Ask yourself?  Does the doctor’s description of the patient describe enough symptoms to conform to the diagnostic manual’s definition of the disorder?  Did the doctor describe enough Mental Status Examination to support their diagnosis?  Do the psychological testing scores demonstrate the patient was both truthful and disordered?  Asking the right questions is the first step to understanding that psych report.

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 #14-Get Questions to Ask the Doctor

What kinds of Cx questions do I provide in an Apricot™?  They are questions I would not want asked of me if I were the doctor being deposed.  No telling what effect they will have on the doctor being deposed but they are questions that would make me feel embarrassed and humiliated if I wrote their report.  Most importantly, an Apricot™ provides the attorney with all of the information that they need to back up their questions and get to a point where it is obvious that  the conclusions in the doctor’s report are flawed.

More help for cross-examining psych doctors can be found at my website and in my book Psychological Evaluations in Litigation: A Practical Guide for Attorneys and Insurance Adjusters.

Sub Rosa Videos and Psychological Evaluations

During the slightly more than 30 years I have been conducting workers’ compensation and personal injury evaluations in the State of California I have participated in the examination of between 5,000 and 10,000 patients. In the last decade the majority of those examinations have been Agreed Medical Evaluations for workers’ compensation purposes. In the course of conducting those evaluations I have watched my share of sub rosa video surveillances. How relevant are those recordings?

Overall, the average sub rosa video depicting an individual walking down the street, driving a car, going shopping, gardening, talking to a friend, smoking a cigarette etc., has little value in providing information relevant to drawing conclusions about their psychological status.

Read More
See more from Dr. Leckart

Cross-Examining Psych Doctors - Tip #13-Deciding Which Questions to Use in Cx

What kinds of Cx questions do I provide in an Apricot™?  They are questions I would not want asked of me if I were the doctor being deposed.  No telling what effect they will have on the doctor being deposed but they are questions that would make me feel embarrassed and humiliated if I wrote their report.  Most importantly, an ApricotTM provides the attorney with all of the information that they need to back up their questions and get to a point where it is obvious that the conclusions in the doctor’s report are flawed.

More help for cross-examining psych doctors can be found at Dr. Leckart’s website  and in his book Psychological Evaluations in Litigation: A Practical Guide for Attorneys and Insurance Adjusters.

Psychologists v. Psychiatrists

Who Best to Hire as an Expert? Psychologists have either a Ph.D. or a Psy.D. degree in psychology.  A Ph.D. is a research oriented degree whereas a Psy.D. is a treatment oriented degree.  Psychiatrists have M.D. degrees.  Psychiatrists are trained and more knowledgeable about psychotropic medication and treatment, which are rarely concerns in litigation.  Psychologists are trained and more knowledgeable about psychological testing than psychiatrists.  In most psych medical-legal reports the basic question is, “Has the claimant suffered a psychological injury?”  The answer hinges on the doctor’s diagnosis.  Both psychologists and psychiatrists use five sources of information to arrive at a diagnosis, the three most important of which are:  the patient’s life history and their presenting complaints, the doctor’s Mental Status Examination results and the objective psychological testing data.  Of the three only the psychological testing provides objective information about a diagnosis and patient credibility that can be presented to the court.   Given the above, “Who do you think can write a more credible and comprehensive medical-legal report?”  “Who will provide better testimony?”  Finally, consider this.  I’ve read at least 30,000 psych reports over the last 30 years and cannot recall ever reading a single one in which a psychologist found it necessary to hire a psychiatrist to help with the examination.  In contrast, I frequently see reports written by psychiatrists who hire psychologists to interpret the testing.  "What does this tell you?"  “Who do you want on your side?”

More help for cross-examining psych doctors can be found at Dr. Leckart’s website (www.drleckartwetc.com) and in his book Psychological Evaluations In Litigation:  A Practical Guide for Attorneys and Insurance Adjusters (http://drleckartwetc.com/wp-content/uploads/2012/10/FINAL-051311.pdf).

California Exclusive

   For some seven years I have been writing a newsletter that for the most part was dedicated to discussing psychological issues in the medical-legal area involving worker's compensation and personal injury litigation. Initially, the distribution of the newsletter was to attorneys and insurance adjusters with whom I had some professional connections with in California.

   As time has progressed, I am happy to say that my newsletter has been picked up by a variety of people in many different areas throughout the United States and in many foreign countries. Many of these readers were initially sent the newsletter by people in California and some connected through my website, where all of the previous newsletters are available. (www.drleckartwetc.com)

[To read more click here or to read all previous newsletters visit the website at www.drleckartwetc.com]

Helping Cross-Examine Psych Doctors

After 30 years of medical-legal reporting I developed a system for cross-examining psych doctors that exposes the flaws in their reports.  When I write that information in a work product privileged report to help an attorney CX
a doctor I call that document an Apricot™.  You can also write your own!
Check out the self-help resources for writing  Apricots™ at my website (www.DrLeckartWETC.com).

Free Cx help can also be obtained from downloading a copy of my book Psychological Evaluations in Litigation: A Practical Guide for Attorney and Insurance Adjusters (http://drleckartwetc.com/wp-content/uploads/2012/10/FINAL-051311.pdf).

Measuring Patient Credibility in Psych Legal Evaluations

Since the patient provides most of the data used to draw conclusions about their psychological status, the first responsibility of any medical-legal evaluator in a psych case is assessing the patient’s credibility. But how does a doctor tell if a patient is being honest and straightforward?

If you’re an attorney, insurance adjuster or another mental health professional what do you look for in the doctor’s report to see if the patient was telling the truth and if the doctor established their credibility?

There are four different places in the report to look for data demonstrating the patient’s credibility: the Mental Status Examination, the patient’s life history and presenting complaints, the psychological testing data and the patient’s medical records.

Click here to read more from Dr. Leckart.

What is an Apricot™

An Apricot™ is a work-product privileged report used to assist an attorney in taking a psych doctor’s testimony. An Apricot™ describes all of the substantial flaws in a psych report in jargon-free, non-technical language. An Apricot™ also provides a list of questions and techniques that get those flaws on the record despite that might be the doctor’s evasive or non-co-operative behavior.   

An Apricot™ is used when the attorney decides there is weakness in a psych doctor’s report that needs challenging during a deposition or trial testimony.

Cross Examining Psych Docs Tip #4

Cross Examining Psych Doctors - Tip #4-Credibility is Key

The first responsibility of any medical-legal evaluator is to demonstrate the patient’s credibility.  One measure of credibility is the objective psychological test scores in the doctor’s report.  There are three psychological tests often found in medical-legal reports that are capable of providing such data:  the Minnesota Multiphasic Personality Inventory (MMPI), the Cattell Sixteen Personality Factor Test (16PF) and the Millon Clinical Multiaxial Inventory (MCMI).  A discussion of these tests can be found in my book Psychological Evaluations in Litigation:  A Guide for Attorneys and Insurance Adjusters that can be read or downloaded for free at www.drleckartwetc.com where you can also find copies of my monthly newsletters addressing psychological testing in detail.  An attorney can prepare for a deposition or trial by determining if the scores indicate that the patient was exaggerating, embellishing, over-reporting or attempting to simulate symptoms or telling the truth.

More tips and free tools for help in cross-examining psych doctors and preparing briefs for the court can be found at Dr. Leckart’s website:  www.drleckartwetc.com

Team Approach To Med-Legal Psych Reports

I was recently asked to write an Apricot™ for an attorney planning to depose a psychiatrist. The psychiatrist was jointly selected by the attorneys involved in the case to perform a medical-legal evaluation. In reviewing the doctor's report it became apparent that the doctor's colleague, a psychologist, extensively participated in the evaluation of the patient and signed the report.

I was sure to point out that the Labor Code for this particular jurisdiction discusses the responsibilities of the physician who sign a medical-legal report. This section of the code is clear in stating that "no person other than the physician who signs the report, except a nurse who is performing some specific duties such as taking blood pressure, shall examine the injured employee or participate in the nonclerical preparation of the report" including the taking of a complete history, reviewing and summarizing the medical records and composing and drafting the conclusions found in the report. Since it appears likely that the psychologist was not the provider selected by the parties, although he signed the report, the court may be interested in the issue of whether or not the extensive participation in the evaluation violates that section of the Labor Code and has resulted in a situation where that report does not constitute substantial evidence.

More tips and free tools for help in cross-examining psych doctors and preparing briefs for court can be found at www.drleckartwetc.com 

D.I.Y. Deposition Prep

  
   I recognize that some attorneys have cases where an Apricot^TM is not needed or, perhaps not authorized by the carrier.  It might be handy for an attorney to have an outline of things to do when planning take a psych doctor’s deposition testimony without my help. Here is a list of 10 things to do when preparing to take a psych doctor's deposition without my help.

1.      Decide that you are going to attack the major problem in the doctor’s report that is invariably their diagnosis. 

2.      Learn the definition of the diagnosis by reading the DSM-IV-TR.  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 psychiatrist and Professor at Duke University, who was the chairperson of the DSM-IV and DSM-IV-TR Task Force, Dr. Thomas Insel, the psychiatrist who has been the Director of the National Institute of Mental Health for over a decade and has concluded that the weakness of the DSM-5 is “its lack of validity,” and the Center for Medicare and Medicaid Services (CMS).

3.      See 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. 

4.      Determine if there are sufficient data in the doctor’s report of their MSE to diagnose the disorder or disorders they diagnosed.  An 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 or affect, as well as measurements of the patient’s memory, concentration and attention, insight, and judgment that have bearing on the possibility of psychopathology. 

5.      Determine if there are psychological testing data consistent with the doctor’s diagnoses.  Information about the psychological tests can be found in my book, Psychological Evaluations in Litigation, 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.

6.      Determine if the doctor cited any medical records from any mental health professional who agreed with their diagnosis and decide if that doctor’s report or reports were credible. 

7.      Decide never to ask the doctor about the patient, only the content of their report.  If you ask about the patient the doctor is then free to discuss anything, not just the data in their report that led to their conclusions.  Needless to say, that discussion may contain assertions that are not credible for a variety of reasons, the most disturbing of which is that the doctor is simply “creating stories.”   

8.      Decide never to ask the doctor about the extent of permanent psychiatric disability, apportionment or treatment as those questions can always be answered by the doctor taking refuge in their “professional opinion.”  The problem here is never with your questions but with the concepts of disability, apportionment and the need for treatment, which are totally subjective. 

9.      If you don’t have a copy of the DSM-IV-TR buy one used at Amazon.com and take it to the deposition and conspicuously display it so the doctor understands that you know what you are talking about. 

10.   Write out 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 and when the doctor goes off the “deep end” and gives you a long-winded discussion that contains unresponsive answers, incomprehensible jargon or “word salad,” simply go back to your original simple question and keep asking it until the doctor provides an answer.