"You told the doctor that, didn't you?"
Sometimes they didn't. The instruction letter did.
I've seen this issue come up in different forms over the years. A medicolegal report contains a statement about a claimant's history. Later, someone asks the claimant about it and they say they never told the doctor that.
The natural reaction is to wonder who's got it wrong.
But there's another possibility that doesn't always get enough attention. The information might have been in the material sent to the doctor before the appointment.
Having helped coordinate tens of thousands of independent medical examinations, I know how much information can pass between the referrer, the expert and the claimant before a report is finalised.
What interests me is whether we can always tell where that information came from once it's in the report.
Three sources, one history
An independent medical examiner draws on three main sources when taking a history.
There's what the claimant tells them during the examination, what the instructing party has included in the referral, and what's already documented in the medical records.
There can be other material too, depending on the matter.
The expert needs to consider the relevant information and reach their own independent opinion. That's their job.
But the different sources don't necessarily tell the same story.
The question is whether the report makes it clear which account came from which source.
Because there's a difference between a claimant telling an expert something and an expert reading it in the documents.
It sounds obvious when you put it like that. It becomes less obvious when everything is brought together into a few paragraphs under the heading History.
Why it matters later
Take a hypothetical example.
An instruction letter says a claimant returned to full duties six weeks after an injury.
During the examination, the claimant explains that they attempted to return but couldn't sustain their normal hours.
The final report says the claimant returned to work after six weeks.
That might be an accurate summary of what the instruction letter said. It might be the expert's interpretation of the available records. Or it might be what the claimant actually told them.
Without some indication of the source, it's difficult for the next reader to know.
Now imagine that statement being raised with the claimant months later.
"You told the doctor you were back at work after six weeks."
The claimant disputes it.
The expert may have done nothing wrong. The claimant may be entirely correct about what they said during the appointment. Both things can be true.
The difficulty is that a statement originally taken from one source is now being treated as though it came from another.
A point Don Cameron raised
Don Cameron, Managing Lawyer at Don Cameron & Associates, made an interesting observation in the comments on Issue 10, where I wrote about AI scribes and the recording of medicolegal examinations.
His argument concerned the value of a full recording when a claimant is challenged about something supposedly said to an examining doctor, particularly where the information may have come from the instruction letter or other records.
That got me thinking about a related question. If something came from the referral material, can we distinguish it from what the claimant actually said during the examination?
That doesn't mean the expert shouldn't consider the information. Of course they should, where it's relevant.
And it doesn't mean the claimant's account should automatically be preferred over the clinical records.
It simply means we should know which account we're looking at.
For the expert, it makes the reasoning easier to follow and reduces the chance of their report being misunderstood.
For lawyers and claims professionals, it helps identify whether an apparent inconsistency is actually an inconsistency.
And for the claimant, it means they're not being asked to explain words that may never have been theirs.
What would help?
Many experts already make these distinctions in their reports.
They'll write that the claimant reported a particular symptom, that the referral letter described a particular event, or that a treating doctor's notes recorded something different.
That approach is useful. Not because every statement needs a footnote, but because the reader can see what the expert was working with.
For example:
"Mr Smith reports that he attempted to return to work after six weeks."
"The letter of instruction states that Mr Smith resumed full duties after six weeks."
"The treating records describe a graduated return to work over several months."
Those are three different statements. An expert may consider all of them, explain any inconsistency and reach an opinion about their significance.
That's very different from combining them into one account without showing where the information originated.
I'm not suggesting reports need to become longer or more complicated. Most are already substantial documents, and experts have enough demands on their time.
But when a fact is material to the opinion, a few words identifying its source can save considerable confusion later.
The bottom line
"You told the doctor that, didn't you?" should be a question with a checkable answer.
Often, the expert knows where the information came from. The report just doesn't always make that clear to the next person reading it.
Being specific about the source helps everyone. The claimant isn't held to words they never used. The expert's reasoning is easier to follow. And lawyers and claims professionals can focus on what the evidence means rather than spending time establishing where it came from.
We spend a lot of time discussing the accuracy of medicolegal reports.
I think we should pay just as much attention to whether the reader can tell which source they're looking at.
When you pick up a report, how quickly can you tell what the claimant said from what the file said?