AMA Guides® Newsletter - Issue Archive

Articles

1. Herniated Lumbar Disc: Excerpt from the New AMA Guides to the Evaluation of Disease and Injury Causation, Second Edition

   Pages 1–5

   DOI: 10.1001/amaguidesnewsletters.2013.JulAug01

   Abstract

   This article presents the current science regarding the causation for herniated lumbar discs, taken from the second edition of the AMA Guides to the Evaluation of Disease and Injury Causation. Sciatica is a relatively common disorder; point prevalence population estimates range from 2% to 5%. People with sciatica may or may not have lumbar disc herniations (lumbar herniated nucleus pulposus). Sciatica is described by a variety of terms, including radiculopathy, lumbosacral radicular syndrome, and nerve root irritation. Different definitions of sciatica have been used in epidemiologic surveys, and studies concerning sciatic pain or sciatica generally have used self-reported risk factors in a cross-sectional design—these studies have drawn contradictory conclusions regarding the risk factors associated with lumber radiculopathy. Insufficient scientific evidence exists to justify attributing the cause of lumbar disc herniation to any minor trauma event or ergonomic risk factor; supposed “post hoc ergo propter hoc” (after this, therefore because of this) associations show only association, not causation. The article includes several tables, including risk factors for lumbar disc herniation, risk factors for sciatica, and a summary of evidence for low back pain.
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2. “Double-Dipping”

   Stephen L. Demeter

   Pages 6–7

   DOI: 10.1001/amaguidesnewsletters.2013.JulAug02

   Abstract

   The goal of impairment assessment is to accurately estimate the loss of structure and/or function due to an injury or illness. The AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) sometimes provides two or more methods for rating a given condition, or, in the case of two or more impairing conditions, it may be inappropriate to rate less significant conditions if the rating for the primary impairment already takes into account the deficit(s). Either scenario offers opportunities for “double-dipping” or rating the same impairment more than once. Duplicative ratings commonly occur when two or more impairing conditions are present in a single organ system and even more often if multiple organ systems are involved. Because of methodological changes, ratings using the AMA Guides, Sixth Edition, are less susceptible to double-dipping than those from earlier editions, especially musculoskeletal ratings. To avoid duplication, the rater must look closely at all elements included in the impairment classes and determine if any similarity exists in the other organ systems or conditions rated (eg, is the patient's coronary artery disease responsible for the diminished exercise capacity, or is it the cardiomyopathy, or is it chronic obstructive pulmonary disease). When two or more conditions are present, evaluators should rate the higher or highest impairment and then eliminate, as much as possible, the influence of similar symptoms, signs, or diagnostic test abnormalities when rating the lower impairments.
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3. A Trial Consultant's View of the Medical Expert Witness

   Deborah Rutt, Kathyrn Mueller

   Pages 7–10

   DOI: 10.1001/amaguidesnewsletters.2013.JulAug03

   Abstract

   Physicians who use the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) often serve as medical expert witnesses. In workers’ compensation cases, the expert may appear in front of a judge or hearing officer; in personal injury and other cases, the physician may testify by deposition or in court before a judge with or without a jury. This article discusses why medical expert witnesses are needed, what they do, and how they can help or hurt a case. Whether it is rendered by a judge or jury, the final opinions rely on laypersons’ understanding of medical issues. Medical expert testimony extracts from the intricacies of the medical literature those facts the trier of fact needs to understand; highlights the medical facts pertinent to decision making; and explains both these in terms that are understandable to a layperson, thereby enabling the judge or jury to render well-informed opinions. For expert witnesses, communication is everything, including nonverbal communication that critically determines if judges and, particularly, jurors believe a witness. To these ends, an expert medical witnesses should know the case; be objective; be a good teacher; state opinions clearly; testify with appropriate professional demeanor; communicate well, both verbally and nonverbally; in verbal communications, explain medical terms and procedures so listeners can understand the case; and avoid medical jargon, finding fault or blaming, becoming argumentative, or appearing arrogant.
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4. AMA Guides to the Evaluation of Disease and Injury Causation, Second Edition

   J. Mark Melhorn, James B. Talmage, William E. Ackermann, Mark H. Hyman, Richard T. Katz

   Pages 10–11

   DOI: 10.1001/amaguidesnewsletters.2013.JulAug04