What a difference 18 years makes. I was a rarity way back in 1997, when I became a Legal Nurse Consultant and it was still a fairly new specialty practice. Hardly anyone knew what an LNC was, much less what to do with us. Nowadays, you can hardly swing a stethoscope without hitting one, and attorneys and claim representatives better realize the value of using a skilled LNC to evaluate a claim or review complex medical records.
So what makes an LNC great and how do you know? And, if you are a LNC, how do you know if you are providing maximum value to your client?
Here are my top 5 traits of an expert LNC:
- Excellent writing skills. Nurses routinely write in short, fragmented sentences. They are taught to document pertinent information in an abbreviated way. That style does not make for easy reading unless you are medical provider who understands the lingo and, more importantly, knows the patient being charted. The thought and fluidity of what is being conveyed is often lost. In the LNC world, our end-user is usually a nonmedical person. So, the nurse needs to take the medical information, summarize it in her mind and then write about it in a way that an attorney or adjuster can fully and clearly understand. Be sure to follow the client’s instructions when doing this, as sometimes a specific reporting format needs to be followed.
- Meticulous work product. Misspelled words, inaccurate provider names, incomplete or wrong dates, and poor sentence structure ruin the credibility of your work product. Fair or not, we are and will be judged by our written and verbal communication skills. A poor work product speaks to the LNC’s lack of integrity about their work and eye for detail. If you turn in a sloppy product, how does the client know that you did not also do a subpar review of the medical record? And, equally important, it potentially says to the client 'You are not very important to me.'
- Forensic thinking. A case’s information must be analyzed from all angles. You have to think like the opposing counsel as well as the insurance handler. You may have to figure out why a provider did what they did. This type of thought process or critical thinking is necessary, because without it, the work product will not hold water when it’s tested or reviewed carefully. Many nurses think that just because they are nurses, they naturally understand the medicals and, therefore, the key issues of a claim or file. Nothing could be further from the truth. The medical facts and issues are just part of the picture. How those facts play out through the prism of a lawsuit or claim varies greatly. Be sure you fully understand the client’s needs and instructions so you can address all requested issues.
- Effective medical reporting. At times, nurses may forget to include all the necessary medical information, or forget to document a critical medical fact. This is a big issue when the reader is less knowledgeable of the medical information than the nurse reviewer. The reader will rely on the nurse to find, detail and explain the medical information, as well as highlight why it’s important to their claim or file. I have seen nurses document a fact one way and then document it another way later in the chronology or timeline. I have also seen nurses forget to document diagnostic findings, comments by the injured party or providers as well prior history and more. Consistency of facts throughout the chronology timeline is critical.
- Understanding of the biomechanics of injury. Research. Research. Research. I cannot stress this enough. Don’t guess on this one. Don’t let your emotional side or lack of understanding drive you to a wrong or incomplete conclusion. Nurses are not biomechanical engineers, attorneys or claims representatives, but having a basic understanding of how the alleged event/incident affects the body is crucial to understanding how the injury/incident is (or is not) part of the claim or law suit. Did the injury cause a new problem? Did it exacerbate a pre-existing condition? Is there permanent damage documented? Remember correlation does not always equal causation. Know the medical facts within the record. What are the physical impact points sustained in a fall or MVA? What caused the impact? Understanding the initiating event helps to set the stage for medical analysis.
Though my top 5 traits of an effective LNC is hardly an exhaustive list, I hope it provides a better picture of what it takes to be successful. Need to brush up on your skills? AALNC provides educational opportunities for everyone, from seasoned LNCs to those just starting out.
--Kari Williamson, BS, RN, LNCC, CCM
MKC Medical Management
President's note: This blog post is a guest post written for our Summer Series where new voices from the Legal Nurse Consulting community will be shared. Enjoy!