In the civil litigation and workers’ compensation fields, medical experts are often called on to give opinions about whether a particular medical condition was caused or contributed to by a specific injurious event or by the conditions of the claimant’s employment. Often these questions are directed at doctors whose daily practice involves primarily diagnosis and treatment, and not determining a medical causal relationship between medical conditions and events. As a result, when faced with these issues, some doctors resort to assessing causation on a purely subjective basis: i.e. the patient’s self report. Fortunately, the American Medical Association’s Guides to the Evaluation of Disease and Injury Causation provide evaluators with a protocol for making scientifically credible findings on causation.
The Protocol provided by the Guides is a six-step process. Failure to complete any of the steps in a manner that supports a causal relationship eliminates credibility for claims of injury-relatedness or work-relatedness. The six steps are:
- Definitively establish a diagnosis: Is there any objective and credible evidence of a diagnosis that might explain the examinee’s clinical presentation (complaints, symptoms, signs, etc)?
- Apply relevant findings from epidemiologic science to the individual case: Has the claimed cause (in this individual case) been scientifically identified as a significant risk factor for the diagnosis? What are the most well-established risk factors?
- Obtain and Assess the Evidence of Exposure: Is there evidence, primarily objective, of exposure to the claimed cause of the clinical presentation and what is the relationship in time between the exposure and presentation?
- Consider other relevant factors: Are there other risk factors that contribute to the development of this clinical presentation? Are any relevant here?
- Scrutinize the Validity of the Evidence: Is there conflicting information? Have other examiners provided opinions lacking in scientific credibility?
- Evaluate the Results from All of the Above Steps, Generate Conclusions