Document ovzGB7jXMyDqMGrrG0JezRmX

FILE NAME: Saranac 7th Symposium (SSY) DATE: 1952 DOC#: SSY033 DOCUMENT DESCRIPTION: Transcript of Presentation by Dr. Braun with Discussion TAKE* 7B0M PAGE 640. B J S S I P B BEAM* KLm Donlac, Hr. V eters, Mothers o f tb s flysposiuau I t I s ay m isfortune not to bs able to attend the e a r lie r sessions o f th is n estin g and fr c a ercryttiin c I has* hoard, th i has *rtolaly hose outstanding and eery suoeessful* Doctor Tom ald sad h is a sso e icto s should bs congratulated . B is o a lib s r o f the papers e a r lie r th is corning ashes a s fe e l a l i t t l e Inadequate fr c a ths standpoint o f **** a n y th in to Eanrur, during mgr tem tre as a ed lo a l d irecto r o f a la rg e corporation, I se e e ra l tin e s had the opportuni t y to ca tch my n sd leal eellea eu es spend eons e ery uneasy accen ts as n sd lea l w itn esses, exp ert v ltn e sa e s, In oantroce rtod IN D U S T R IA L H Y G IE N E F O U N D A T IO N O F A M E R IC A , INC. Me l l o n In s t i t u t e , 4 4 0 0 F ifth Av e n u e PlTTSBUROH 13, PA. Septem ber 3, 1952 Dr. A rthur J. Vorwald D irecto r STahreanSaacraLnaackeL, aNbeowratYooryrk D ear Art: In accordance with your request, I am enclosing a copy of the paper which I w ill present on Septem ber 26. accordinIghotopeyothuart wyiosuhreps raenpda rIaktinoonws tfhoart tthhee SSyymmppoossiiuumm awriellpbreocaeehduigneg success. Best personal regards. Yours DCBtfns enclosure . D aMnieedl iCca.l BDriaruenc,toMr , D. AM ASOClAT>OM or M O U I T m U r O M T H E A O V A N C E M E K T O f HEALTMfUL * O m i K O O M O m O M S 641. compensation hearings. I knee they eere esteemed In their professions, high caliber, capable. They allowed themselven to say things and do things which were embarrassing not only to themselves but to others* Most of this arose, I would say, through failure on the ioian to observe c e r t a i n fundamentals* embarrassment I part of the phys' k beaic consideration In the presentation of med ical evidence Is that the real purpose of the hearing Is to bring about a Just and equitable adjudication of the claim. If a medical witness never losee sight of this concept, he will not permit his position to become one of zealous part isanship. Such la not the proper function of the expert medical witness* He has a clear duty to testify when called and to present the medical facts aa clearly and concisely as pos sible in order to aid the report and proper lntrepretation of these facts* It should be obvious that this function la of the utmost Importance in establishing whether the claim ant has been disabled as a result of an accident or occupa tional disease and the nature and extent of euch disability* The performance of this duty requires of the med ical witness the same high level integrity as doea the every day practice of his profession. If we present supposed ade quate training and experience on the part of a physician, there remain two main requisites for proper medical testimonyj 642 First, his adequate preparation of the cases However well trained in the profession and in hla speciality the witness is, the witness is not necessarily an expert in the case at hands I have never quite under stood how or why ao many doctors assume that they can d&ah into court and testify extemporaneously. It seems to ms that for his own sake and in justice to the claimant, the doctor should be willing to prepare his testimony with the same careful attention to detail with which the lawyer pre pares his case* *ow, admittedly, this horrible example which ww were using, generally has with him the hospital records which he nervously leafs through while mumbling his testimony into his lap. This, in itself, detracts from anything ha may have to say. Really adequate preparation of medical testimony requires that a physician keep complete records on the case from the beginning. All cases of personal injuryor illness arising in the course of occupation are of the type wnlch F, W. Callen has deadribed os high medico-legal potential, , In such cases, he lists the following components of a full nedl.ca.1 record* A record of the physlclal status of the per son before the specific event of the accident or the expos ure; an accurate description of the event and a record of subsequent changes in the individual, I o.m sure that, by A 2* this, he includee adequate and frequent X-rays# The Importance of X-rays at the time of the ac cident and during the progress of the case needs to be tressed. Certainly, with such records, the medical witnes# should not be in the embarrassing position of relying on hin memory or contradicting his own statements with respect to the record# Helpful as the medical records may be, they con stitute only a portion of the preparation of his testimony. Hypothetical questions are frequently put to the expert witness and he should give adequate thought beforehand, to the possibilities of such questions and the answers based on a reasonable chain of causation# In this connection, it would be well for the physician who M y be oalled as a witness to consider the case from the broad viewpoint instead of confining his thinking to the location, fixation of a frac ture, he should regard the person who sustains the fracture as a complete individual, the effect of the fracture on hie future physical and emotional status, and a possible con nection with pre-existing or co--existing pathological con ditions# One of the obstacles to good testimony and, there* fore, to a Just disposition of the case is the frequency with which witnesses are caught off guard by a question which they did net anticipate, because their thinking was rf m* _MjL too narrowly circumscribed. For example, consider a situ ation In which a nan dies while working In an atmosphere known to contain some concentration of carbon monoxide. Autopsy shows beyond question, that death was due to coro nary occlusion# The medical expert testifys that coronary artery disease was the approximate cause of death and that death was Inevitable because of the pathological condition# Various questions are then asked him concerning the conditions which exist in the coronary arteries, wfaich led to coronary occlusion. He discusses ths changes In the arterial eet--up, and suddenly he Is asked whether a nan with this eet of conditions wouldn't be more likely to have a heart attack If he was working In a carbon monoxide and a portion of his hemoglobin were saturated and hence not aval] able for transportation of oxygen. Possibly because he Is not acquainted himself, with the effect of various concen trations of carbon monoxide In the blood or because he felled to determine the level of carbon monoxide In the blood in this particular case or because he failed to Inquire Into the concentration of carbon monoxide In the environment, be finds himself In a weakened position and is gradually forced to admit that carbon monoxide may have aggravated the maun*a condition# This exact altuation may seem to be exaggerated, but it is not. It illustrates the neceselty of acquainting oneself with allof the information available, i It may be necessary that in the preparation of a I given case, a physician will view all of the latest liter- j ature in order to apprise himself of the newest dedislons. , j A second requisite for good medical testimony In- | volves the conduct of the witness and this, too, may be im proved by virtue of proper prepation. He must not only be scrupulously honest in his testimony, but his deportment must be such as to impress the referee and the Jury that ha I Is honest. He should, of course, conduct himself in a | gentlemanly manner on the stand and refrain from flip and glib remarks, any flippancy and argumentation. To allow himself to become bombastic or pompous quickly indicates to the court that he is not sure of his ground and Just as quickly leads to retaliation in kind by the opposing attor ney. I Any witness, to improve the quality of the medics] testimony and add to his own composure, if he will remember to take time to be sure that he understands the question directed to him and the Implications of his answers before formulating his reply. In the matter of actual testimony, it Is important^ ! I | to face the referee or the Jury and to enunciate clearly an4 jj distinctly. One of the most common criticisms and probably \ the most Justified,of medical witnesses, is their tendency M S* to testify in the jargon of medical textbooks. A compensa tion referee or commissioner, In evaluating medical testi mony, should be aided by the use of simple medical language whenever the occasion calls. While it is certainly unwise to make dogmatic statements, especially in hypothetical matters auoh as those dealing with aggravation, aggravation of pre-existing conditions, one of the things most deplored by lawyers is the lack of a definite expression on the part of a medical witness when such might be expected of him. If he is, in fact, an expert, he should be pre pared to state his opinion and not resort to vague terms such as probable or possible. The same vagueness also fre quently appears in support of a witness* estimate of per centage of disability. The estimate of disability should be based upon some reasonable standard, though I will ad mit opinions differ very widely in respect tothose standard! In most opinions of this kind, the X-ray films play a very Important part. The witness should familiarise himself with the rules regarding their admission in evidencA in the particular jurisdiction. Films have to be properly identified. Their interpretation should be regarded as a privileged communication. The medical wltneas should re member the limitations of the X-ray, should be frank to say j so if the findings are equivocal. He should properly cor- I I relate the X-ray in the clinical findings without attempting I __________________________________________________________ S47* to over-emphasis# the X-ray or, on the other hand, to sake It conform to the clinical aspects of the case* In the matter of chest X-raye, It Is important to remember that, to be of value, they should be made under certain specified conditions of technique, length of expos ure, for example, should not exceed a tenth of a second and the films reading distance should not be more than four feet* I do not wish to leave the impression that most doctors are poor witnesses or that all differences arise be cause of their shortcomings* The evidenoe in such cases is bound to be controversial and it is expecting a great deal to ask that the physician alone remain entirely objective* There are other reforms which could be made, which could contribute greatly to the obtaining of good medical testimony in controverted cases* For one thing, there is the need for more training in the medical-legal disciplines in our medical schools. Legislation <hiould give greater consideration to the value medical boards such as the Doctor McGee has of neutral medical examiners or j Longshoremen's Act provides* I very ably dealt with tnis subjectj this morning* Mr. Waters has consistently pointed out ths j I value of such impartial testimony and about twenty states j now provide such boards. The pernicious practice of one j side or the other, employing a physician who is willing to j testify for the highest bidder, can be minimized by the made i leal society and the bar association concerned, working j i together in the manner of the Minnesota Plan. This joint effort of the Minnesota judicial coun cil and the State Medical Association, results in a review of testimony given by medical witnesses* If such review is requested by the judge or a physician or an attorney repre senting either side. The review is done by a committee of physlelans who are aided by three specialists in the par ticular field Involved# It has resulted in a more careful and more honest testimony on the part of medical witnesses* Another great need is for standard criteria on which to base disability compensation. In dosi n g , I believe that the most important single reeord for the presentation of medical evidence la the scrupulous honesty of the witness# This, I think, cam be illustrated by an ami sing story which is told by Doctor I Henry Rowland, then Professor o r Physios at Johns-Hopkins University. During his suit against the public utilities company, he was asked by the celebrated Joseph H. Choate* in cross-examination, who was the greatest living physicist* Doctor Rowland, unhesitatingly replied *1 am"# Afterwards*| --hen asked by President Oilman Eoplrins #Kjr be gas* th at ans-l I wer, he smilingly replied that it was a little embarrassing* but after all, he was under oath. i (Appiausa) ' M 9a BY MISS DOMLOMt Thank you very much, Doctor Braun. Thank you too, for lightening the, sometimes I think, density of our acadei< le thinking, vith that nioe little story. We now are going to have, not merely the two gen tleaen whose names you see on the program for this morning*! session, who both speak to the extent that they do not spea): impartially, and I 'a sure they all do, speak acre directly ! from the viewpoint of employers, and Doctor Vorwald, after Ji I the program had been set up, realised that it would be very i i helpful to have, among the viewpoints presented this mornlnf l else, the viewpoint of those who speak in behalf of the claimants, and I ahall lntroduee the gentlesun who will speak on that viewpoint a little later. Right now, you're going to have the Manager, I think his title is, of the Department of Workmen's Corape n satlon for Bethlehem Steel Company, and before he moved te that position, a practicing lawyer, who has had a great i i t deal of experience in this field. Mr. Frank Bamako of Bethlehem Steel Company. Frank. BY MR. BARSAKOl (Mp, B a m a k o read a prepared paper which ia on file at the Saranae Laboratory). i BY MISS DON LON 1 Thank you very much* Mr* Bama k o , and again, on y* i i tit : i ' 4 j t. . *AMAKO September 22, 1552 *Ti Proaontatico of Medical Evidence In Controverted Ctspenaation. Caaee", which I will preaent at the Sarenec Syapoeitta September 26. 1952. I here foor additional ooples of the papar which I will bring along with at on fbureday. Looking forward to aeelag pea than. Tory tr*ly joera. Trank R. Bamako Or. Arthur J. Vcrwald Directory Tbo Trodean Praadation aal The Saranac Laboratory P. 0. Box 551 Saranac Laka, Be* Torit adc attach . !r y T in s r a tf paoi 649 TET ^ pom s T'ni'V joq w r y , Mr. Bu-nako, and ac*in, behalf of By colleagues from administration, I want to ap plaud your closing remarks. We welcome that attitude and thank you for it* Wow, w# all recognise, I'm sure that no expres sion of the viewpoints of compensation for pulmonary or any other workmen's compensation claims, for that natter, would be complete without an expression of the viewpoint of the disabled workers, the claimants in workmen's compensation cases, and that it seems is particularly trua with regard to the presentation of medical evidence in a controverted condensation oase, and so Doctor Vorwald has invited to be here today, and he is here today, the gentleman from Buffalo who represents now. District Wo. S, the United 8teelworkeri of America in Buffalo, in their workmen's compensation work, However, he had a long experience before that working for carriers, so he has quite literally seen both sides of the workmen's compensation claiau X presume - I present him to you to discuss the viewpoint In behalf of the clainants. Mr. J. H. Tiernan of Buffalo. KV VR. TIEKSAK t Mlse Donlon and Ladles and Gentlemens I felt rather lonesome when I arrived. All my frlenda that wera here at the sympoeium usually sit in the other aide of the table, but I was interested in hearing my friend from Beth lehem etate that he attempted to be impartial. I do not