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Neurology - Chapter 11 - Preparing And Winning Medical Negligence Cases - Third Edition
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NEUROLOGY
James C. Johnston, MD, JD, FCLM, FACLM
§ 11.01 Introduction [1] Preface Neurology is arguably the most difficult and exacting medical specialty, requiring a thorough understanding of fiendishly complex topics such as neuroanatomy, neurophysiology, neuropathology and neuropharmacology. There are ghastly diseases presenting with baffling symptoms. It is extraordinarily challenging for an outsider to understand the distinctive terminology, bewildering examination techniques and medieval-appearing diagnostic methods. Moreover, the unprecedented evolution of neurology is creating an ever-changing landscape of testing procedures and therapeutic options. The attorney trying to overcome these barriers faces two additional hurdles. First, there is a paucity of literature providing guidance through a neurological malpractice case. The many excellent textbooks, monographs and journals covering this specialty are written for practicing clinicians and are of limited value to the lawyer trying to ascertain whether a malpractice claim is meritorious. Second, neurologists, like most physicians, have limited understanding of the legal process and may not present clinical information in a useful manner, making it even more burdensome to review a case. The resulting dearth of information can make a neurology case seem forbiddingly complex. This chapter attempts to bridge the gap by providing an overview of neurology for the legal profession and other nonphysician readers. It is not a substitute for the extensive nosological approaches of conventional medical writings. Nor is it a treatise of neurological malpractice; indeed, an impossible feat for a single chapter or even a single volume. Rather, it is designed to provide the attorney with a rudimentary understanding of the specialty in order to more effectively evaluate neurological opinions, thereby determining the strength, and identifying the weak points, of a case at the earliest possible stage.
[2] Outline Parts I, II, and III define neurology; summarize the education, training and certification of a neurologist; and outline the various types of practice. Hopefully this will help the lawyer assess experts’ credentials. Part IV provides a list of reputable textbooks, journals and internet sites as a starting point for further research on specific neurological topics. Practice guidelines are discussed. Part V is an abbreviated synopsis of the structure and function of the nervous system, which is best read in conjunction with one of the recommended neuroanatomy texts. It is the most intimidating section of the chapter, akin to learning basic conversational terms of a new language. However, this background is a prerequisite to understanding the neurological examination, role of diagnostic testing, and mechanisms of disease. The neurological evaluation is outlined in Part VI. A solid understanding of this part will help the lawyer effectively review medical records and minimize the risk of overlooking a significant sign or symptom. Part VII reviews common neurodiagnostic testing procedures with an emphasis on the indications for and limitations of each procedure. Part VIII highlights the scope of neurology with descriptions of common disorders and diseases. The material to be reviewed is a mer à boire, which necessitates omitting many conditions, truncating differential diagnoses, and ignoring various diagnostic and therapeutic options. It focuses on the more frequently encountered malpractice issues. Part IX briefly discusses medical records and the expert witness role.
JAMES C. JOHNSTON, MD, JD, FCLM, FACLM. Consultant Neurologist and Attorney at Law, Texas and Washington, USA; Barrister and Solicitor of the High Court of New Zealand, Auckland, New Zealand; Diplomate of the American Board of Psychiatry and Neurology; Additional Certification in Neurorehabilitation; Fellow of the American College of Legal Medicine, Fellow of the Australian College of Legal Medicine, Member of the New Zealand Law Society.
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