MEDICAL PHYSICIANS

Medical PhysiciansEvaluating
What is forensic medicine?
How is forensic evaluation different from clinical evaluation?
Can I perform a forensic evaluation on a patient I am treating?
What is an IME or Independent Medical Examination?
What questions should I ask during a forensic examination?

Writing
How are forensic reports different from clinical reports?
How can I write an effective forensic report?

Testifying
Remember your role in court!
Be prepared!
Your testimony starts with your report.

Coaching
What is forensic report coaching?
How does forensic coaching work?
Do I have to reveal that I received coaching?
How do I start?

Templates
How to use report templates.

What Is forensic medicine?

Forensic medicine is the application of medical science and experience to the legal system. Physicians are called upon to explain medical illness and treatment to the court to help resolve legal questions related to disability, malpractice, and other issues.

You do not need to have forensic training or certification to become an expert medical witness in a case. In fact, only psychiatrists and pathologists have accredited specialized training in forensics, because their expertise is routinely required in court.

The American Academy of Forensic Sciences has represented forensic specialists from all disciplines for over sixty years. If you are interested in developing forensic expertise and practice, you should consider joining the organization and attending its fascinating, multi-disciplinary, annual conference.

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How is forensic evaluation different from clinical evaluation?

A forensic evaluation is focused on answering a legal question and may not be as expansive as a general medical examination. On the other hand, your interview, physical examination, and medical studies may need to delve more deeply into the areas that are pertinent to the legal question, for example, to resolve questions of malingering or discrepancies in the evidence.

You should always start a forensic evaluation by informing the subject of the purpose of the examination and limits to confidentiality. You should stress that you are a doctor by profession but have been hired to perform an independent evaluation to answer a legal question, not to provide medical treatment.

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Can I perform a forensic evaluation on a patient I am treating?

Treating physicians are commonly asked to provide opinions about disability and need for treatment to insurance companies and other parties, but this poses several obvious conflicts and potential sources of bias. As a physician, your ethical obligation is to help your patient and do no harm. In contrast, a forensic medical examiner needs to be objective, skeptical, and able to serve justice rather than the interests of the patient who has hired him or her.

If an attorney asks you for a legal opinion on your own patient, you should suggest that he or she hire an independent physician instead. You can steer the attorney in the right direction while demonstrating your ethics and familiarity with the forensic process so that the attorney considers retaining you on future cases. You may also contact insurance companies or their brokers and offer your services as an independent medical examiner, if you are interested in forensic work.

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What is an IME or Independent Medical Examination?

The most common type of forensic evaluation performed by medical physicians is the Independent Medical Examination (IME). An IME is an assessment of clinical impairment, performed by a physician who is not involved in the patient’s care, as part of a legal determination of disability. The definition of disability varies across jurisdictions, depending on the relevant state laws and regulations and the federal Social Security Act, Americans with Disabilities Act, and Family and Medical Leave Act. The American Medical Association’s Guides to the Evaluation of Permanent Impairment (the Guides, 6th edition, 2008) provides guidelines and standards for conducting IME’s.

If you are requested to perform an IME, you should use the AMA’s Guides (some states may still refer to the 5th edition) and the specific procedures, standards, and forms in your jurisdiction. You may be able to register with your state to perform such evaluations. Some referring attorneys or insurance administrators may use the term IME more loosely to refer to any independent, forensic medical evaluation.

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What questions should I ask during a forensic examination?

A forensic examination, similar to a clinical examination, should include an exploration of the subject’s chief complaint, history, physical examination, and investigative studies. You may need to ask questions particular to the legal issue. For example, in a disability case, you would want to ask about specific impairments and challenges experienced by the subject and look for confirmatory signs of those complaints and limitations during your physical examination. Since most plaintiffs stand to gain financially from their cases, you need to explicitly consider the possibility of malingering (faking or exaggerating illness). You should keep notes of your examination, in case they are entered into evidence.

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How are forensic reports different from clinical reports?

Forensic reports are analogous to clinical reports in organization, with sections corresponding to the history of present illness, history, course of treatment, mental status examination, diagnostic tests, diagnosis, and formulation. Forensic reports differ from clinical reports primarily in that the intended audience is composed of laypersons -- judges, juries, and attorneys -- rather than other clinicians.

Because the audience for your report has no medical knowledge, you should not use professional jargon without explanation. Whereas clinical documentation is often sloppy and full of abbreviations, forensic reports should be written clearly and in proper English to make a good impression and avoid obfuscation.

Forensic reports also differ from clinical reports in their conclusions. Clinical reports culminate in treatment recommendations; forensic reports culminate in a legal opinion. The forensic opinion is formed by applying your clinical findings to answer a legal question. You will need to understand and bridge the gap between clinical and legal concepts. For example, a patient may be genuinely ill yet not be disabled according to a particular agency’s or jurisdiction’s definition.

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How can I write an effective forensic report?

A forensic report is well-written if it clearly communicates your findings. A well-written and convincing report may lead to the satisfactory resolution of a case without further deposition or testimony on your part.

The skill of forensic report writing can be taught and mastered. You can begin to learn to write forensic reports by using the templates below and studying my forensic report writing tips. I have also listed a number of other report writing resources. You can also contact me for coaching on a particular report and apply what you learn to future cases, with or without my assistance.

Download Forensic Medical Report Writing Tips (PDF 48 KB)

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Remember your role in court!

Most clinicians are terrified the first time they are called to testify in court. Nothing in your clinical training prepares you for the adversarial setting of the courtroom, where your communication skills, clinical judgment, and reasoning are tested under fire in front of a neutral, but skeptical, judge or jury.

To survive the ordeal, you need to remind yourself that you are in the courtroom to assist the judge and jury understand medical elements of the case, not to help one side or the other win. In fact, I recommend that you turn and address your answers to the judge or jury rather than responding directly to the attorneys when you testify. You are a consultant who has expert information to share, not an agent trying to impress one side or the other. You should answer questions respectfully and informatively on cross-examination, just as you do on direct. You do not want to appear defensive and biased. Keep in mind that even the process of cross-examination is intended to help the court understand your opinion, not to undermine your integrity.

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Be prepared!

To perform well in court, you need to be prepared. If you have already written a comprehensive forensic report, you can take it to the stand, but you should refresh your memory before you testify and be able to give your diagnosis and other basic facts without having to turn and fumble through your report. You should also be aware of any additional information that has come up since you first evaluated the subject, such as intervening opinions by other experts.

The attorney who has retained you will usually want to “prep” with you before you appear in court. The attorney will tell you what questions he or she is likely to ask and will want to know how you are likely to answer. If the attorney has made incorrect assumptions about your testimony, this is the time to clarify your position, so that he or she is not surprised by your answers on the stand. You and the attorney may also try to anticipate what questions the opposing attorney is likely to ask during cross-examination, so they do not take you off guard.

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Your testimony starts with your report.

The best way to prepare for court is to write a clear and convincing forensic report. In fact, if your opinion is well-expressed, without omissions or inconsistencies, then the case may be resolved without further testimony.

I can review and coach you on a particular forensic report, with an eye towards presenting a strong case for eventual testimony. You may also wish to review my testifying tip sheet or explore the other testifying resources that I recommend.

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What is forensic report coaching?

The best way to learn a new skill is to be trained by an expert. Forensic psychiatrists and pathologists are fortunate to have supervisors and mentors who reviewed their work and fostered their skills during fellowship training. But many physicians would like to expand their practice into the forensic arena. Forensic coaching provides you the opportunity to receive expert feedback from an experienced forensic expert so that you can create a convincing forensic report, gain confidence in forensic evaluation, and develop your professional skills in an exciting new direction.

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How does forensic coaching work?

Forensic reports should be able to stand on their own. They contain within them all the data necessary to justify your opinion. I have reviewed thousands of forensic reports over more than ten years, and I can quickly spot discrepancies, missing information, and potentially confusing language based on a review of the report alone. Even though I am a psychiatrist by training and not always familiar with the state-of-the-art in other medical specialties, I can evaluate your report on its own merits. I can suggest ways you can strengthen your argument, sometimes by acknowledging the limitations of your opinion or the alternative explanations you have considered. You might want to consider also asking a colleague in your specialty to review your diagnostic work-up

I supervise reports via the internet using the editing tools within word-processing software. I can make editorial changes and comments for you to consider and then accept or reject. I can also review reports in hard copy, making editorial suggestions by hand, but this is less efficient. I have been through this process of editorial supervision myself, as a book author and writer of forensic reports. It is easy and effective and can have a dramatic effect on the quality of your final product: a clear and convincingly-argued forensic report.

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Do I have to reveal that I received coaching?

Forensic coaching is a form of indirect supervision, in that I have no direct involvement in the case and no responsibility for your opinion. The report remains your own, and no one needs to know that you have received coaching, unless you are asked on cross-examination. I am not aware of anyone else who offers forensic coaching services, so I think such a question would be highly unlikely, and it could be answered unapologetically. Seeking feedback from a colleague in medicine is rightly considered a sign of diligence rather than weakness.

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How do I start?

You can begin to improve your forensic skills immediately by utilizing the resources on this web site. Download a forensic report template and my forensic report writing tips.

If you want Dr. Hicks to review your forensic report, please use the instructions in the "Word editing tools" tip sheet and send the report to the e-mail address below, after removing identifying information. Dr. Hicks will respond as quickly as possible with the cost to review your report. The cost may vary based on the length of the report, the extent of editing needed, and the format (a PDF scan is the most difficult to review, a report written using one of Dr. Hicks’ Word templates is the easiest). Payment can be made easily using the Pay Pal link in the sidebar.

DrHicks@forensicmind.com

Download tips for using Word editing tools (PDF 75 KB)

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How to use report templates.

The following templates are in Word format. I have kept formatting to a minimum so that the templates are easy to use and the resulting report easy to read. I have inserted instructional comments into the templates to provide some initial guidance, and you should also review my forensic report writing tips. You can open and save these templates in other word-processing formats if you wish, but Word has easy-to-use editing tools that allow me to review your report and make suggestions, should you decide to receive forensic coaching.

If you wish to use a clean template, you can delete the instructional comments by clicking on the icon with the red X in the “reviewing” task pane and selecting “delete all comments in document.”

Templates available for download:

Personal Injury

Disability

Sample Contract

Medical Malpractice

Blank Report

Medical Evaluation

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