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“My lawyer told me to ask you....”: Patients who have personal injury lawyers frequently utter this statement.  It is a drain on your time to try to give the patient verbal answers to the lawyer’s questions, and it is unlikely the patient will accurately convey the answers back to the lawyer.  In this situation, it is best to quietly and calmly let the patient know that it is unfair for him/her to be placed in the role of information courier.  Explain that this method of communicating information is seldom accurate and that you will gladly answer the lawyer’s questions if he/she will send them to you in writing.

Disability Evaluations -- Important Terms:

Maximal Medical Improvement (MMI): The point in time following an injury when the physician determines the patient is “as good as he’s going to be”, or when he has recovered as much function of the injured part as he is likely to recover following a particular injury.  Permanent partial impairment is determined once a patient has reached MMI, and impairment ratings should not be given before a patient has reached MMI.

Impairment:   What the physician determines.  It is the amount of deficit, usually expressed as a percentage, in an injured part compared to what it was in the normal state (usually prior to injury).  It is determined based on objective medical findings and its determination is aided by state guidelines for workmen’s compensation and an AMA guide otherwise.  It is a medical determination of the patient’s functional capability.

Disability:  What the insurance company or Worker’s Compensation Board determines.  This is how much the permanent partial impairment is worth to the patient in dollars and cents.   This is calculated based on the physician’s rating, but the monetary payment to the patient is not determined by the physician.  Many patients do not understand this -- you should assist them in understanding your role in the process of settling disability claims.

On the wards

Surgical nutrition: Consists of adequate: 1. calories, 2. protein, 3. vitamins and 4. minerals. Other concerns, i.e. fat, fiber, food groups are not necessary for the surgical concern of wound healing.

Achieving adequate surgical nutrition: This can be difficult in some patients, especially alcoholics. However many alcoholics will eat peanut butter if it is provided in large quantities and they are encouraged. It is high in calories and protein. A vitamin and mineral supplement can be given to round out the program. Good lifelong nutrition? No, but it might get the wound healed!


Copies:  You can tell a copy from an original x-ray because it has little notches cut in the end of the film.  


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