Top 7 Tips for Presenting Your Credentials for Medical Legal Work Patricia Iyer MSN RN LNCC President, Med League Support Services, Inc

Top 7 Tips For Presenting Your Credentials For Medical Legal Work Patricia Iyer MSN RN LNCC President, Med League Support Services, Inc. and co- presenter of an all new webinar on polishing your writing skills.

Choose between a resume and a curriculum vitae (C.V.) . A resume is a brief (no more than 1-2 pages) summary of your educational and employment history. A C.V. is a longer and more detailed description of education, employment, awards, honors, publications, membership in professional associations, and offices held. To properly demonstrate expertise, legal nurse consultants and expert witnesses are more likely going to prepare a C.V.

1. In your C.V., include the important and basic information. Don’t overlook adding your phone number and email, as well as an address. Avoid adding extraneous details such as religious affiliation, names and ages of children, hobbies and interests. 2. List each of your jobs in reverse order, starting with the most current job. Include the starting and ending years, the name of the employer, your title, and a brief description of your job responsibilities and accomplishments. 3. Look at your background through the eyes of the attorney who is reviewing your credentials. Stress your clinical experience if you are seeking work as an expert witness. Avoid stating you serve as an expert, as this makes you look like a hired gun. Avoid including education you completed to become a legal nurse consultant if you are seeking expert witness work, as this may make you look like a “legal nurse” rather than a “clinical nurse”. 4. Design your C.V. to make good use of white space, bold, and serif fonts. For example, don’t crowd your C.V by using a small font. Allow one inch margins all around. Place bold on the names of the places where you worked, and then unbold your job description and accomplishments. Use a serif font (with little feet) rather than a sans serif font. Serif fonts are perceived as friendlier. Avoid difficult to read fonts. 5. Thoroughly proofread your C.V. and ask another person to check it as well. Typos on a C.V. can be enough to take you out of consideration for being hired. Check dates carefully. 6. If you worked in more than one place during the same time frame, place (part time) after your position to help someone who is reviewing your C.V understand the overlap. Otherwise, your overlapping dates may be seen as typos.

7. Keep your C.V. current on an ongoing basis. It is far easier to produce an updated C.V. in a hurry than it is to have to make changes under pressure.

Top 7 Ways in Which Writing for Attorneys is Different From Writing for Professors Patricia Iyer MSN RN LNCC, President of Med League and co-presenter of an all new webinar on polishing your writing skills

Many legal nurse consultants have college degrees and recall laboring over term papers. The writing you do for attorneys is different from academic writing in several ways.

1. Academic writing is heavily cited. The more footnotes, the better, according to some professors. Reports written for attorneys may contain some footnotes or links to internet sites, but this are usually kept to a minimum.

2. The person reading an academic paper can be assumed to understand common terms. The language you used was familiar to the reader - your professor. The attorney may not be familiar with terms and medical conditions. The attorney appreciates definitions and spelled out abbreviations.

3. Your professor typically gave you an expected number of pages for your paper. The attorney will rarely define page length for a report.

4. A professor rewarded you for a paper that went into great depth, and explored each nuance of a subject. An attorney wants you to get to the point. What are your conclusions, analysis, and the pertinent facts? The attorney is busy and often does not have the time to wade through volumes of material. The attorney needs you to prepare a focused report, providing details and facts related to the issues in the case. The attorney may not be willing to pay for an unfocused lengthy report containing too many irrelevant details.

5. Your professor started the semester by telling you when your assignments were due. You knew well in advance. Your attorney client may give you a rush assignment that requires you to set aside other priorities and pour out the energy needed to complete the work. If the client does not provide a due date, the LNC must be sure to complete the work in a timely manner.

6. In college, you often had a certain latitude in selecting what you would write about. The topic you picked for a term paper may have been one that intensely interested you. When you help an attorney with a case, you may have little or no choice about which case you are given to work on. Furthermore, you may have little familiarity with case issue or have little interest in that particular medical issue.

7. Colleges share guidelines about their requirements for a writing style. They define what system to use for citations, the number of inches for margins, the cover page

layout, and so on. Attorneys rarely define the expected layout for a report, chronology, or timeline. This flexibility, and emphasis on content rather than format, gives the legal nurse consultant an opportunity to be creative.

Both your professor and your attorney client are interested in clear writing that conveys information in a meaningful way.

Build your LNC Practice through First Impressions Dana Jolly, BSN, RN, LNCC, Principal, Jolly Consulting, LLC & Legal Nurse Consulting Institute, LLC and co-presenter of an all new webinar on polishing your writing skills

The first report a LNC produces for a new client is equivalent to a first impression. We all know how important first impressions are. For LNCs, they can have even more significance. A good report highlights the value of a LNC. It can launch a LNC career, revive a struggling LNC practice or expand a growing LNC practice. Busy litigators are only going to give LNCs one chance to make a good impression through their work product.

The LNC’s clients need to be able to “hit the ground running” with the medical facts. They need a tool to quickly identify the medical facts and understand the implications of those facts on their case strategy. Analytical and writing skills are critical in developing such a tool. A poorly written analysis does not help the client. The client won’t see the value the LNC brings to the litigation team and in all likelihood, that LNC won’t be given another chance. So, how does a LNC write a report that will WOW their client turning a one-time client into a customer for life?

Here are a few tips on performing spot-on case analysis to get started.

1. Remember the purpose of the report. I think of this as the bottom line of the report. What is it the client needs to know? Identifying the issues of the case with the client ensures the LNC will deliver the information the client seeks.

2. What format does the client prefer? Some LNC clients won’t have a preference. If they do, of course follow it (at least for the first report). If the report is a narrative account of the facts, it should read like a story. Other formats include tables, bulleted lists, and timelines. Regardless of how the information is presented, objectivity and brevity are paramount.

3. Be clear on deadlines. When does the client expect the report? It is always good when a LNC can exceed the client’s expectations. One way to do this is to produce a report ahead of the deadline.

4. Develop a system to review medical records Identify relevant providers from whom records should be requested/subpoenaed. Organize those records chronologically and provide the client with an easily navigated set of all provider records. 5

5. Draft the report The first task is identifying relevant medical facts found in the medical records. Focus on critical documents/facts identified by the issues in the case. For example, if the case involves an organ injury during surgery, chances are EMS and ED records are not critical. The next task is the analysis portion of the report. Analysis uses the LNC’s informed opinions. Begin analysis by focusing on the purpose of the report. For example, medical malpractice analysis focuses on the delivery of health care and its outcomes. Personal injury analysis focuses on related injuries. Analysis also includes the impact of injuries, significance of preexisting conditions, and discrepancies/inconsistencies. Address central issues in simple terms. Do the medical facts support the plaintiff’s allegations? Remember, the report is a communication tool. Be sure it is easy to understand. Always keep the end in mind – how will this report be used by your client?

Common Pitfalls in Report Writing Angie Duke-Haynes, RN is President of Premier Medical Legal Consulting, LLC, co- owner of Legal Nurse Consulting Institute, LLC and co-presenter of an all new webinar on polishing your writing skills.

The inexperienced legal nurse consultant learns in the same way as the new clinical nurse – through on the job training. In nursing school we gain a tremendous amount of “book smarts” in the classroom but the most valuable training is accomplished in the clinical setting. Likewise, a nurse can learn the basics of legal nurse consulting though nothing solidifies this knowledge like hands-on case review experience. As an educator in a legal nurse consulting education program, I have seen the inexperienced, though highly educated, legal nurse consultants make the same common mistakes. Just a few of these frequent pitfalls are described below:

1. Failing to include a medical analysis and recommendations in your report. The inexperienced legal nurse consulting may be so focused on the chronology that he/she may forget to include the analysis of the findings. Yes, this has actually happened! Providing the attorney with the chronology without an analysis and recommendations will not result in a repeat customer. Do not lose focus on the purpose of the report. What is your client asking you to do? A paralegal skilled at reading medical records may be able to create a chronology, but a legal nurse consultant uses medical knowledge to see beyond the facts of the case and to help the attorney understand the implications of the details. 2. Not asking enough questions. Who is your client: an attorney, risk management department, or insurance carrier? Is this a plaintiff or defense case? Is this a personal injury or a medical malpractice claim? I have seen beautifully written reports making a great case for the plaintiff when the client is actually representing the defendant. If you aren’t sure who your client is representing you need to ask. The plaintiff attorney represents the patient but there are many attorneys working on the defense side. These attorneys may represent the physician, nurses, pharmacists, or equipment manufacturing company, for example. If a plaintiff’s case has progressed into the discovery phase it is helpful to ask how the opposing counsel is defending the case. You can then assist the attorney to build a stronger plaintiff case. Always keep your client’s needs in mind. 3. Focusing on the wrong issues. When in doubt, go back to the basics. Clinical nurses know to focus on the ABC (airway, breathing, and circulation) in the event of an emergency. Legal nurse consultants must always be sure that the four basic elements of negligence are present when performing a case review. For example, newer LNCs (aka ‘newbies’) may so fixed on the blatant breaches in standards of care in a fall case that they fail to recognize there are minimal damages representing no real dollar amount. Always ensure there are breaches in the standards of care as well as damages. In cases with limited damages you

may want to have a conversation with the attorney to determine whether there are enough damages to justify moving forward with litigation. 4. Failing to thoroughly review and edit your report. This is your work product and therefore it is representative of you. If your report contains misspelled words, inaccurate information, does not follow a reasonable sequence of events, or it does not look or sound professional it is not likely that the attorney will use your services in the future. Take a step back away from your report once you are finished before coming back to proofread and edit the report. Do not rely on solely on spell check to catch your errors. 5. Failing to interpret critical medical issues and define medical terms. Referencing laboratory data and medical terminology without defining the terms or explaining the significance is not helpful to the attorney. If the patient died from cardiac arrest in the presence of severe hyperkalemia you must explain the correlation between these two findings. Too often inexperienced legal nurse consultants write their material as if the reader was a medical professional, not a legal professional. Worse yet, they may write a report as if they were charting in a medical record. Be sure your client can understand your report and utilize it throughout litigation.

Expert Witnesses: Supporting Your Nursing Opinion Angie Duke Haynes

As an independent legal nurse consultant, with over a decade of experience who has reviewed dozens of expert cases and thousands of “behind the scenes” cases and provided deposition and trial testimony, I believe that one of the most important duties of a LNC is to provide the attorney all the evidence used to support your opinions. Communicating this evidence can be accomplished in various ways. Here are some examples of nursing home cases in which I used case specific information, other than nursing or physician notes to support my opinions.

1. Physical and Occupational Therapy Notes: My first trial testimony involved a nursing home patient who became trapped in the side rails and was strangulated. As a plaintiff expert, I opined that the patient was not an appropriate candidate for side rails from the very beginning. The nursing staff documented that she used the side rails to assist in turning and positioning. The nursing and nursing assistant documentation was inconsistent about the resident’s ability to turn in the bed. The nurses and aides described her on a continuum from completely independent to requring extensive assistance to being totally dependent.

In this case, I relied heavily on the physical and occupational therapy notes as they treated the resident five times weekly for a period of months prior to her death. This documentation consistently showed the resident was unable to use the side rails to her benefit; she required total assistance to turn and position in bed. After reviewing page after page of therapy notes in the courtroom, the judge asked how many more examples were left. When I indicated we were just getting started, the judge stated he had seen enough evidence. This case resulted in a plaintiff verdict.

2. Flow Sheets: In one case, I heavily relied on the ADL Flow Sheets as they consistently showed the resident was eating less than 50% of most meals and refusing supplements without appropriate nutritional intervention. In another case, a neurological assessment flow sheet clearly documented a resident’s change in condition over a 12- hour period after a fall including unequal pupils, left-sided weakness, and a severe headache. Yet, despite these obvious changes, there were no nursing interventions until the patient was found obtunded early the next morning. He expired soon after arriving to the hospital.

3. Facility Policies: Sometimes supporting evidence is not found within the medical record itself. The information needed to support your opinion may be found in the facility’s policies and procedures or other internal documentation tools. I once had a choking case in which a patient who was prescribed a mechanical soft diet choked on cooked carrots and asphyxiated. The autopsy report was very specific; it described the size of each piece of food removed from the pharynx. Each piece measured approximately ¾ inch x ¾ inch. The facility’s policy for mechanical soft diets was equally specific, noting foods must be cooked and chopped no larger than ½ inch x ½ inch. Bingo! That case quickly setttled out of court. 4. 24 Hour Reports: Likewise, defense cases have been quickly put to rest due to good nursing documentation. In one case the nursing staff was cleared of negligence by their documentation of specific information communicated to the physician on the 24 hour report.

5. Incident Reports: Incident reports can be obtained by the plaintiff attorney in certain cases. When the incident report is referenced in the medical records it opens the door to retrieving the document. In a frequent fall case, my review of the incident reports revealed the batteries in the chair/bed alarm were dead on one occasion; twice the unit was turned off; and in yet another fall the alarm was not in use. This helped to prove negligence of the nursing staff.

Angie Duke-Haynes, RN is President of Premier Medical Legal Consulting, LLC, co-owner of Legal Nurse Consulting Institute, LLC and co-presenter of an all new webinar on polishing your writing skills. Tips for Improving Writing Skills

Patricia Iyer

Today, people are using very different writing styles, not just what you learned in school from your English teacher. Informal writing has changed. Text messaging, in particular, has caused us to think in terms of brevity of communication. But the real risk in brevity is that you are going to miss things and you will not be able to fully convey what you want to say, particularly within a business environment.

Getting exposed to poor writing is a big source of frustration for many people who work in professional fields. And there are errors and risks to people and to systems if we can’t communicate well in terms of what we know or instructions that we need to give other people.

The ability to write fluently in an easily understood manner is not going to go out of style. There are people who see typos and get focused on the typos and say, "Oh wait a minute, let me look at that word, it doesn’t look right. Oh, she spelled that wrong." Poor writing makes us take a few seconds away what we are reading in order to filter that through the editor in our minds. When writing is done beautifully, you don’t notice it; when it’s done poorly it jumps out and it distracts you from the message.

Tips for Improving Your Writing Skills

1. Do a lot of reading. Sit with a book either in paper form or on an electronic reader like a Kindle or Ipad. Notice how the author forms sentences. Do the words flow? Exposure to good writing of people who are fluent in the language improves your skills. Conversely, reading poorly written material is painful. 2. Write a report or essay. Set your material aside for a day and then proofread and edit it. Look for places where you can compress the sentences, improve word flow, and improve clarity. 3. Ask someone with good writing skills to be a copyeditor to help you improve. A copyeditor improves word flow, in addition to proofreading. A copyeditor will take your material and rearrange it so that it flows better. This person improves the language, grammar, and word usage. 4. Study how the copyeditor changed your material. Incorporate those changes into your writing style. 5. Take a writing course or an English writing composition course at a local community college or local college, or audit the course if you don’t want to take it as a matriculated student. 6. It is important to remember you can always improve. Learn from others’ writing or critiques of your writing. Develop a thick skin and graciously accept criticism so you can learn from it. 7. Read books on writing. One of my favorites is Eats Shoots and Leaves by Lynne Truss, a truly funny book about grammar. Also read The Language of Success by Tom Sant or Plain Style: Techniques for Simple, Concise, Emphatic Business Writing by Richard Lauchman.

Patricia Iyer MSN RN LNCC has been a legal nurse consultant for 24 years. She is president of Med League Support Services, Inc. and Patricia Iyer Associates. She is the author or editor of over 125 books, chapters, articles case studies, and online courses. Breaking Down the Nursing Home Chart Angie Duke-Haynes, RN

If you have never worked in the long term care environment a glance into the medical chart might be intimidating. Flipping through the records in a nursing home chart will reveal many documents specific to this nursing specialty. Nurses without long term care experience may be very hesitant to review one of these cases due to their lack of knowledge of these industry specific records. Once you understand where important information is located within these medical records you can use them to support your analysis of the matter.

One of the most mystifying parts of the nursing home chart is the Minimum Data Set (MDS). The MDS is a standardized instrument used to assess all nursing home patients. It is a comprehensive assessment of the resident’s physical and functional abilities and cognitive status and includes indicators of delirium, fall history, diagnoses, wounds, nutritional status, restraint use, continence status, and more. The nursing and therapy notes and other documentation should be reviewed to ensure the information in the MDS is accurate.

Depending on the timeframe for the care being reviewed, the chart may contain an MDS that may be either version 2.0 or 3.0. After extensive review, the Federal government released the 3.0 version on October 1, 2010. The Resident Assessment Instrument (RAI) now consists of the Minimum Data Set (MDS) 3.0, the Care Area Assessment (CAA) Process, and the RAI Utilization Guidelines. The MDS 3.0 was refined to include many changes including, but not limited to, a focus on pain assessment and discharge planning, when assessments should occur, some changes in coding, and the use of Care Area Triggers (CATs) rather than Resident Assessment Protocol (RAPs). The MDS 3.0 focuses on resident participation through multiple interviews. The “look back period”, the time frame the MDS assessment is based upon, is seven (7) days for all areas unless otherwise noted on the assessment.

There are 20 CAA’s that can be triggered by the MDS responses. The identified triggers are used as a guideline for development of the individualized plan of care. The staff may override the trigger or decide to proceed and create a plan of care. For example, nutritional status may be triggered due to recent weight loss. However, the staff may override the trigger by indicating a recent history of bilateral above the knee amputations, thus justifying the recent weight loss or less than ideal body weight status. The CAA’s should be reviewed to ensure that all potential risks have been appropriately triggered and addressed in the plan of care.

While the Plan of Care (POC) is not paperwork specific to long term care, it is a very critical document and must be closely reviewed to ensure every risk unique to that resident has been addressed and that the POC is individualized to the specific needs of that resident. The care plan is a dynamic tool that should be updated as the needs of the resident change. For example, if the resident is at risk for falls and the goal indicates the resident will have no falls with injury within the next 90 days and that resident does indeed fall and sustained injury, the plan of care must be updated. You should expect to see new interventions to prevent falls.

Therapy documentation is critical to long term care cases. When a resident is involved in PT, OT or ST you will find frequent documentation which can be crucial, especially when there are few nursing and physician notes. Therapy notes will usually describe the resident’s functional ability, level of pain, subjective statements, cognitive status, and safety recommendations. Always be sure to review the therapy records thoroughly and compare these assessments to the nursing notes, physician notes, MDS, and care plan. Likewise, important information may be found in the social services notes as documentation regarding discharge plans, family concerns, and social history is likely recorded in this section.

Don’t allow your lack of familiarity with long term care records hold you back from an interesting case review. Your knowledge of the records outlined above will provide you the ability to thoroughly understand the residents’ needs and determine whether they were met. This information is just a brief overview of a few of the records. However, part of being successful is self educating and knowing how to find the information you need. Identifying a long term care nurse that you can call with questions as needed might just provide you with the added confidence needed to say “Yes” when asked to review a nursing home case.

By Dana Jolly, BSN, RN, LNCC

1. Striking the wrong key Relying on the computer to function as the only proof reader of your LNC report is sure to miss a few common typographical or grammatical errors. An example I frequently see is the wrong word being typed, i.e. “form” when “from” should appear. A lack of attention to detail is guaranteed to have your client second guessing his request to have you review the critical evidence in his case.

2. Blind side your client Do not include any references: source document, Bates numbers, literature citations. You don’t want your client to easily find the critical document or the article that supports the case theory. Attorneys really do want to search through all those medical records themselves.

3. One and done Just provide the facts and your conclusion. Don’t include recommendations for the next steps the client should take. After all, the report speaks for itself. Attorneys, being familiar with the provision of health care, can easily identify just the specialty needed for an expert review. All attorneys understand the difference between a diagnostic radiologist and an interventional radiologist, for example.

4. Missing the point Make your conclusion hard to find. Place it anywhere but the beginning of your report. Attorneys love to read the whole report before they learn what your conclusions are. Placing your conclusion at the beginning of your report with emphasis formatting would make the attorney less inclined to read your entire report, something to be avoided at all times.

5. TMI* When in doubt, include it. It is important the attorney is made aware of all potential breaches in the nursing standard of care regardless of the relevance to the allegations.

* too much information

Dana Jolly, BSN, RN, LNCC is president of Jolly Consulting, LLC, a national legal nurse consultancy. She is a published author and frequent lecturer on legal nurse and clinical topics. Long Term Care Primer – Specialty Documents Dana Jolly, BSN, RN, LNCC, is Principal of Jolly Consulting, LLC.

Long term care is a highly litigated area of health care. As a legal nurse consultant (LNC) without a clinical background in long term care, I had to educate myself on this specialty. The nursing tasks were familiar but the chart was not. As I worked on more of these cases, I came to rely upon a uniform set of documents that provided a good starting point for LTC case analysis: Minimum Data Set (MDS), Resident Assessment Protocols (RAPs) and the Care Plan. Starting my analysis with these documents gave me information on baseline function, skin condition, cognition and more. From there, I could wade through the piles of nurses’ notes, nursing assistant checklists and medication administration records looking for the details I needed to provide my clients with the meaningful tool they required to litigate the case.

History

In 1987, Congress passed the Omnibus Budget Reconciliation Act (OBRA). This legislation set specific standards for all Medicare certified skilled nursing facilities including a detailed assessment of the patient that was linked to their plan of care. What came out of this legislation was the Resident Assessment Instrument (RAI). Don’t let all the acronyms confuse you. The RAI standardizes communication regarding the person’s medical problems and conditions both within the LTC facility and to outside healthcare providers. The RAI enables the nursing home to track changes in a patient’s status and evaluate their individualized plan of care. So, you can see how the RAI is a great place to start a medicolegal analysis.

Specific Documents of the RAI

 Minimum Data Set (MDS) provides a detailed assessment of the patient that is linked to that person’s individualized plan of care. The MDS includes information on people’s cognitive and functional abilities along with their physical condition. The MDS is a goldmine for a LNC. One of the best things about the MDS is consistency throughout all facilities in the United States. Of course, there is a twist to this. A revision of MDS - MDS 3.0 - was rolled out in late 2010 with an expanded section on skin conditions. It is critical to analyze cases according to the standard of care in place at the time of the alleged negligence. If the events took place in 2010, the new MDS 3.0 would not be applicable. Please refer to Angie Duke Haynes’ article devoted specifically to this new version of MDS.  Resident Assessment Protocols (RAP) is the next step in the RAI. Based on the MDS, certain protocols are triggered. Think of these as “problems”. Included in these protocols are risk factors that prompt care planning. A RAP summary is part of the MDS. It is a checklist and includes which RAPs are triggered, date of assessment documentation and where that document is located in the record, i.e. speech therapy note. Again, this form is consistent among all facilities in the U.S.

 Care Plan – There is nothing new or different about a LTC care plan. Nurses in all specialty areas assess, plan, implement and evaluate based on the individual patient’s needs. The key in long term care is to review the care plan to ensure it is consistent with the MDS and RAP. As with all case analysis, the care plan is reviewed to ensure the nursing staff identified issues and appropriately provided interventions and evaluated those interventions.

Practice Pearls

 Educate yourself if this is a new area of nursing for you. Utilize resources such as National Pressure Ulcer Advisory Panel (NPUAP), Agency for Healthcare Research and Quality (AHRQ) Clinical Practice Guidelines, RAI User’s Manual and The Long Term Care Survey. Be careful to use resources during the time for which the alleged negligence took place.  Compare the MDS to the RAPs and the care plan. Is the information consistent? Then compare the clinician progress notes including therapy notes. Note relevant inconsistencies in your analysis.  Were changes in function or cognitive status identified appropriately? Was the plan of care adjusted based on the change in status? Where is the evidence to support or refute the standard of care being met?

Dana Jolly, BSN, RN, LNCC, is Principal of Jolly Consulting, LLC.

8 Top Uses of Expert Witness Reports by Patricia Iyer MSN RN LNCC

1. The expert’s report is a succinct and strong statement of the expert’s opinions about liability, causation, or damages. 2. The expert may craft a report to refute the position of the opposing expert. 3. The expert’s report demonstrates the written communication skills of the expert including command of facts, ability to be articulate, and understanding of the format and language required by the legal system in that state. 4. The report may create a positive or negative impression and directly impact the LNC's ability to obtain more work. 5. The expert’s report is served before the discovery deadline to bring litigation to its next phase. 6. The report is used by attorneys to prepare questions to be asked of an expert during a deposition. 7. The expert may be held to the “four corners” of the report during a deposition or trial. Any additional new opinions may be barred. 8. The expert will use the report to prepare for deposition and trial, to review the list of documents that were available at the time the report was written, and to anticipate the cross examination.

As Sam Davis, Esq. of Davis Saperstein and Salomon said, “Legal nurse consultants need to prepare careful and thorough reports. Their reports may be seen by many people during the litigation process. These could include clients, claims handlers, claims supervisors, partners, associates, paralegals, other medical and expert witnesses and the judge. The report may create a positive or negative impression and directly impact the LNC's ability to obtain more work.”

Are You Writing in Geek?

Pat Iyer

Imagine you are an attorney who has hired a legal nurse consultant to summarize and analyze complex obstetrical medical records. You don’t understand medical terminology and you know that the information in the record is crucial to understanding the case. You give the records to the nurse with the expectation that you will receive a coherent, analytical summary of the chart, a description of the standards of care, and an analysis of the deviations, if any, from the standard of care.

The legal nurse consultant submits his report, and you read this:

Assess fetus in distress via continuous electronic fetal monitoring (EFM). Evaluate FMR tracing noting:

a. Uterine activity 1. Tachystole - hyperstimulation (>5 UCs in 10 minutes or closer than q 2 minutes) 2. Polysystole – coupling, ineffective labor pattern 3. Hypertonia – palpate for uterine relaxation following contraction 4. Absence of uterine tone – uterine rupture 5. Tetanic contractions >90 seconds long or >70 mmHg in strength (IVPC)

Huh?

Geek, better known as medicalese or nurse talk, is highly technical language. It is too obscure for the intended reader, in this case, an attorney. It ignores the knowledge base of the attorney and assumes a level of understanding of medical terms and abbreviations. It can result in frustration for the attorney and loss of future work for the legal nurse consultant.

This wording comes from the website of a legal nurse consultant as a sample of work product. In this example, only one abbreviation is spelled out. The terms describing abnormal labor are not all defined, and the non-obstetrical reader is left in the dark – not what you want.

How to avoid geek

1. Write for the reader. Remember that attorneys are not healthcare personnel. 2. Avoid overestimating the knowledge of your reader. Few people are offended by simple language. 3. Spell out abbreviations the first time you use them. 4. Explain medical terms the first time you use them. Consider adding a glossary at the end of your report. 5. Simplify. 6. Do not write as if you are charting. Use full sentences. 7. Ask a non-medical person to read your report before you submit it. Is the material comprehensible? If not, rewrite and edit your work until it is simplified.

Pat Iyer MSN RN LNCC is president of Med League Support Services, Inc, an independent consulting firm serving attorneys since 1987. She has written or proofread thousands of reports written for attorneys. She is the chief editor of Principles and Practices of Legal Nurse Consulting, Second Edition and the editor, coeditor or author of more than 125 chapters, books, articles, online courses, or case studies.