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Abstract
The American Medical Association's Guides to the Evaluation of Disease and Injury Causation (Causation) is an important component of the AMA Guides library and delineates a type of evaluation that is distinctly different from a diagnostic evaluation, a treatment planning evaluation, a prognosis evaluation, or an impairment evaluation. Causation provides a protocol for determining whether a clinical presentation, in the context of a legal or administrative claim, may be credibly attributed to a claimed cause. This article presents the evaluation protocol from Causation, provides self-assessment questions (so users can check how well they complied with the protocol), highlights the protocol's value as a model for scientifically credible practice in general, and clarifies that the protocol is relevant to claims that involve issues related to forensic causation. Courts and administrative systems have an extremely unfortunate emphasis on opinions from experts rather than on facts. The protocol from Causation is a good example of how clinicians can focus on facts and avoid surrendering to the court or administrative system's emphasis on opinions. The protocol is standardized, objective, fact-based, and scientifically credible and involves the following: establish a diagnosis; apply relevant findings; obtain and assess evidence of exposure; consider other relevant factors; scrutinize the validity of the evidence; and evaluate results and generate conclusions.
- Abstract
- Emphasis on Fact, Rather Than Opinions
- Avoiding Common Trends Toward Reliance on Unreliable Information and Logical Fallacies
- Relevance to All Types of Medical-Legal Claims
- The Protocol
- Step 1: Definitively establishing a diagnosis
- Step 2: Applying relevant findings from epidemiologic science to the individual case
- Step 3: Obtain and Assess the Evidence of Exposure
- Step 4: Consider other relevant factors
- Step 5: Scrutinizing the Validity of the Evidence
- Step 6: Evaluation of the Results from All of the Above Steps, and Generation of Conclusions
- References
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1.
Melhorn JM, Ackerman WE. Guides to the Evaluation of Disease and Injury Causation. Chicago, IL: American Medical Association; 2008.
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2.
Barth RJ, Brigham CR. Who is in the better position to evaluate, the treating physician or an independent evaluator. Guides Newsletter. September/October 2005:8–11.
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3.
Answers Corporation. http://wiki.answers.com/Q/What_is_the_opposite_of_the_word_opinion. Accessed April 27, 2012.
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4.
Agnes M, Guralnik DB, eds. Webster's New World College Dictionary. 4th ed. Foster City, CA: IDG Books Worldwide; 2001.
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5.
Huppke RW. Facts is dead; long live whatever rules now. Chicago Tribune. April 19, 2012.
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Sinclair DC. Epidemiology in the courtroom: an evidence-based paradigm for the determination of Causation in Compensation Environments. J Occup Environ Med 2010;52(4):456–461.
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7.
Rondinelli RD, Genovese E, Katz RT, et al, eds. Guides to the Evaluation of Permanent Impairment. 6th ed. Chicago, IL: American Medical Association; 2008.
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8.
Barth RJ. Claimant-reported history is not a credible basis or clinical for administrative decision making. Guides Newsletter. September/October 2009: 1–7.
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9.
Barth RJ, Roth VS. Claims of hypertension caused by job stress. Occup Environ Med Rep. 2002;16(9):70–72.
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10.
Carroll LJ, Cassidy JD, Peloso PM, et al. WHO Collaborating Centre Task Force on Mild Traumatic Brain Injury. Prognosis for mild traumatic brain injury: results of the WHO Collaborating Centre Task Force on mild traumatic brain injury. J Rehabil Med. 2004;(suppl 43):84–105.
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11.
Linton SJ. Psychological risk factors for neck and back pain. In: Nachemson AL, Jonsson E. Neck and Back Pain. Philadelphia, PA: Lippincott, Williams & Wilkins; 2000.
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12.
Carragee E, Alamin T, Cheng I, Franklin T, van den Haak E, Hurwitz E. Are first-time episodes of serious LBP associated with new MRI findings? Spine J. 2006;6(6):624–635.
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13.
Ballantyne C. Strange but true: drinking too much water can kill. Scientific American. June 21, 2007. http://www.scientificamerican.com/article.cfm?id=strange-but-true-drinking-too-much-water-can-kill.
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14.
Petzold A, et al. Marathon related death due to brainstem herniation in rehydration-related hyponatraemia: a case report. J Med Case Rep. 2007;1:186.
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15.
Barth RJ. Prescription narcotics: an obstacle to maximum medical improvement. Guides Newsletter. March/April 2011: 1–7.
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