Admissibility is defined as evidence which may be introduced in a court of law.
When you want to build a personal injury practice, the days of advertising, marketing, advertising/educational newsletters and fancy steak dinners to get new patients are over…long over! In educating 10,000’s of lawyers on medical-legal issues from coast-to-coast, the message has become crystal clear; the lawyers will work with you if you are clinically excellent and your work is admissible.
What makes your work admissible is two-fold. First, you have to render your own opinion and second, you must be expert on that opinion.
“An expert witness is a witness who has knowledge beyond that of the ordinary lay person enabling him/her to give testimony regarding an issue that requires expertise to understand. Experts are allowed to give opinion testimony which a non-expert witness may be prohibited from testifying to. In court, the party offering the expert must lay a foundation for the expert’s testimony. Laying the foundation involves testifying about the expert’s credentials and experience that qualifies him/her as an expert. Sometimes the opposing party will stipulate (agree to) to the expert’s qualifications in the interests of judicial economy.”
A doctor of chiropractic is expert in all things related to chiropractic. Spinal analysis, x-ray, adjustments and those issues related to the examination such as orthopedic testing, muscle testing, range of motion, etc. Issues such as disability rating, MRI spine interpretation, causality of accidents (accident reconstruction), head trauma and brain injury, EMG/NCV interpretation and other associated facets of caring for the injured are areas that doctors of chiropractic need to have evidence of advanced (post-doctoral) training in in order for the courts to admit his/her opinion and to have it be considered.
In most courts, simply having sat with a radiologist over 5 years and thereby becoming proficient in reading MRI’s will not make you an expert and your testimony will not be allowed. You must show evidence of formal training.
Many inexperienced doctors erroneously believe that because 99% of all cases settle and never go to court, admissibility issues are moot. The reality is the doctor is the expert in the case and the primary reason the lawyer either prevails or loses the case. Upon the lawyer presenting the medical findings to the carriers and demanding payment for settlement, the carriers usually want to know who the expert is. That is often code for “send me the doctor’s CV,” as the carrier wants to know the strength of the doctor’s credentials and see if they can prevail in court against the doctor.
If the doctor’s credentials are strong, the carrier will consider settling the case with the lawyer. If the credentials are weak, then the carrier is empowered with the notion that in a court of law, the doctor’s work will not be admitted into evidence and the doctor, based upon the lack of formal credentials, will not do well as an expert due to a lack of a knowledge base as evidenced by the absence of that training.
Caring for the injured means being expert, not because you desire to pander to the lawyer with your credentials, but your patients deserve the best care with the most experienced doctor. You wouldn’t want open heart surgery being performed by a family practitioner who assisted on a few in medical school. We are no different. Yes, the adjustment might be the same, but when do you consider ordering an SSEP, BAER or V-ENG? Do I know how thick the slices should be when ordering MRI’s, to get an accurate read, or do I let myself and my patient be taken advantage of by an unscrupulous imaging company looking to maximize profits?
This is the type of training a trauma specialist requires to be expert in caring for the injured. It’s not simply about adjusting the patient; it’s about knowing when to adjust and when to wait. Is any other pathology present that will require you to bring in another member of YOUR team in the healthcare community? Can you coordinate the care of your patient or are you going to abdicate that responsibility to a medical specialist who has no understanding or confidence in chiropractic? The end result of abdicating responsibility will often be losing your patient, as that MD will refer the patient away from you and then your patient will not get the needed care.
In today’s healthcare community, the issue is no longer that chiropractic is not accepted, it is that we are not qualified to care for many conditions that we are VERY qualified to care for if we become expert. Expert means you have to be the “real deal.” You need advanced training, advanced credentials and you have to know how to triage and manage your patient beyond the adjustment because the rule is, If you do not know, you do not touch.
Dr. Mark Studin is the coordinator of the Lawyers Personal Injury Program, a subsidiary of the Academy of Chiropractic, and can be found at www.TeachChiros.com and www.TeachDoctors.com.