You’ve screened the case and now it’s time to draft a more comprehensive report.
I’ve asked the CLNC® Pros to share their best practices for drafting reports. Attorney-clients are more likely to call on you again and again for reports if you follow these 22 strategies:
- Identify the attorney’s preferences
The attorney-client may not always know what they need, but before you provide what you know the attorney needs, you have to first give them what they think they need. Inquire about the intended purpose of the report and any preferences for format and length. Establish whether the attorney wants a brief or more comprehensive report. This will accomplish three things in advance:- You can more easily judge the format (chronology, narrative, etc.) and amount of detail required for the report.
- You can establish a budget before you start drafting the report.
- You and your attorney-client both know what is being requested, which decreases the risk of providing an unwanted, unnecessary or surprise work product to an attorney.
- Keep it real
Assess how much medical knowledge and experience the attorney has with similar cases. Assessing the attorney’s medical knowledge guides you in knowing how much you need to translate the medical record, medical terminology and disease process. For example, if an attorney handles a large number of failure-to-diagnose myocardial infarction (MI) cases, you may not have to include an extensive discussion about anatomy or physiology because the attorney is already familiar with this information. Instead, tailor this portion of the report to the specific case issues regarding this specific MI. Conversely, if an attorney does not have extensive medical malpractice experience with MI cases, you should devote a section of the report to a review of anatomy and physiology, disease process and current treatment protocols. For attorneys at every level, don’t assume they know how the information applies to the case. Keep it real by explaining the application of the information you provide to the specific case at hand. - Perform an audit of all the records and documents received
Notify the attorney of significant missing records and additional records they should obtain for your review. Marcia Bell, RN, BSN, CAPA, CLNC shares, “If the plaintiff alleges an orthopedic injury and the follow up office visit states ‘doing well in therapy’, it’s obvious that there are missing physical therapy records. If there is a referral to a specialist, it’s essential for the attorney to ask whether the plaintiff went to the specialist and to request those records. Often there is a hospitalization with discharge instructions including follow-up with multiple practitioners. Records need to be obtained for each practitioner. If a client is discharged with home health, the attorney needs to request the home health records.” - Do your research before you start writing
Review applicable standards of care and scientific references and identify the sources you will use before drafting the report. This time-saving procedure helps you organize your thoughts and determine where to include the relevant resource material. - Recycle your research from other reports for greater efficiency
Depending on the type of case, you may be able to re-use sections from previous legal nurse consulting reports prepared for similar cases. For example, in two cases involving delay in diagnosis of myocardial infarction, the standards you applied to the first case may be relevant to the second case. Review your other reports on similar cases to determine if any of the material applies to your current case before starting the report. Of course, there is no “one size fits all” approach to report writing. Each case must be analyzed individually, but occasionally, you may be able to avoid duplicating your effort and research. - Study and model LegalNurse.com’s Medical-Related Case Reports
This helps you to easily battle any procrastination urges as you learn to conceptualize your own legal nurse consulting reports. Use and study the Medical-Related Case Reports the same as you study the Core Curriculum for Legal Nurse Consulting®. Model the variety of formats and the depth of the analysis used by other Certified Legal Nurse Consultants. Pattern phrases and apply them to your own cases. These models involve different specialties and incidents, so you’ll find a wealth of information to draw from. And yes, these are real reports written for real attorneys in real cases. - Customize the report format to meet the attorney-client’s needs
Avoid using the same format and length for each and every case. You may wind up including information that is not cost effective or relevant. Instead, write a report that meets your attorney-client’s needs and presents the information in the most logical manner. - Just Do it
Dale Barnes, RN, MSN, PHN, CLNC shares, “Drafting reports, especially if you have a large case load, can be overwhelming.” Calendar specific times (preferably during your most productive time) to draft the report. Marcia Bell shares, “If I notice a deadline is approaching, I set aside extra time to work on that specific report. It can take longer than I think it will to get all of the details put into a logical, orderly fashion that is simple for the attorney to understand. I can honestly say that I have not missed one deadline since I started my CLNC business, and I attribute my success to using my nursing skills to prioritize what’s needed to get reports completed on time.” - Create an outline to ensure you cover all important issues
Outline your opinions as well as your plan for presenting them. A comprehensive report includes some or all of the following:- Services requested.
- List of records, documents and items reviewed and examined to date.
- Issues.
- Bottom-line opinion and case theme.
- Summary of the case facts and relevant information.
- List of significant players.
- Scientific theory and summary of research and standards.
- Specific deviations from and adherences to the standards of care (malpractice cases only).
- Possible defenses.
- Injuries sustained.
- Causation analysis.
- Potential arguments for opposition and how to respond.
- Missing records or evidence of tampering.
- Problems with the case for plaintiff and defense.
- Definitions of medical terminology in simple terms and interpretation of abbreviations.
- Recommendations for additional discovery.
- Recommended types of experts.
- Summary of testifying experts’ opinions.
- Follow-up questions.
- Recommendations for additional CLNC services and necessary attorney action.
- Conclusion.
- Reference list of authoritative texts, standards and publications.
- Consider using an AI platform
An AI platform can organize and expedite the drafting of chronological timelines, plus more. If you choose to use AI be sure the platform is HIPAA compliant. It’s important to note that even a HIPAA compliant platform can be hacked and confidential health information would be unprotected. For that reason always communicate your intention to use an AI platform to your attorney-client. As law firms themselves use AI platforms, they will probably want you to use the same platform they’re using. - Consider how the attorney will use your report
Your report serves myriad purposes such as helping the attorney identify key witnesses and defendants in the case, to guiding them in the discovery process, to helping them prepare for deposition and trial. Incorporate the attorney’s intended purposes into your report. - Provide a bottom-line opinion
The attorney needs to understand what the case is really about to put the facts in perspective. Provide a bottom-line opinion, then present the facts chronologically. The events occurred in a chronological order. Your report should reflect the same. You want to tell an organized story. Have a beginning, middle and end. The result will be a report that not only educates, but also makes sense, keeping the attorney oriented to the timing of the events. - Include only relevant information
Everything in your report should be there for one purpose and one purpose only – to inform your attorney-client of the information necessary to win or settle the case. Every opinion, every paragraph, every table, every reference should serve that purpose. Just because information is in the record does not mean it belongs in your report. Determine whether information is relevant. If it is not, don’t include it. Do not send a 30-page report when it can be distilled into 10 pages. The attorney will appreciate your efficiency in getting to the point. - Address both plaintiff and defense perspectives
The attorney can better represent the client when they know the GOOD, the BAD and the UGLY. - Apply a systematic approach for entering data to keep chronologies reliable
Even a small error in date or time can influence the rest of your report. To minimize such costly typos, enter data from one complete section of the record before moving on to another section. For example, enter relevant nursing and vital sign entries because these data are usually dated and timed and occur more frequently than entries by other healthcare providers. Then, enter relevant lab report data in the appropriate order before moving on to radiology reports. Then place physician’s progress notes and orders (often, untimed) based on the chronology you have already created. In putting the pieces of the puzzle together in this fashion, you may identify other important issues to address in your evaluation and report. - Break up the topics
Break up long paragraphs. Stick to one topic per paragraph, just like your English teacher taught you. - Use lists to communicate a sequence of items
To make groups of related points clear, use bulleted lists. If the sequence of items is important, number the list instead of using bullets, e.g., number a sequence of steps that came or should come in order. - Format consistently throughout the report
Use the same typeface throughout the report (e.g. Arial or Calibri). Refer to dates and times consistently. LegalNurse.com standard is the mm/dd/yy format – i.e., March 5, 2019 is formatted 03/05/19. - Clarify medical terms and abbreviations
Define medical terms and abbreviations on the spot v in a glossary at the end of the report. This is the preferred practice. Whenever you use an abbreviation for the first time, unless you’re absolutely sure your attorney-client is familiar with it, spell out the term, then put the abbreviation in parentheses – for example, advanced cardiac life support (ACLS). Then on subsequent uses of the term, you can simply use the abbreviation. Most acronyms can be formatted without periods. You’re so familiar with many medical acronyms, you don’t even notice them, but if your attorney-client has to stop and look up a term they won’t appreciate your wasting their time. CLNC consultant, Marcia Bell shares, “I define all terms in my reports whether or not the attorney asks for them. Vickie’s advice of giving a little extra in each report to Wow the attorney has been proven valuable many times.” - Correctly shorten units of measure
Use consistent notation for units of measurement throughout the report. In general, abbreviations for units of measurement do not require periods (unless they’re used at the end of a sentence), nor do they require adding an “s” for the plural. For example, use 127 lb not 127 lbs. - Set the report aside
If time allows, put the report aside for one or two days before conducting final proofreading and editing. Check the report for overall continuity and format. Review each paragraph for content and relevancy. Be sure you deliver what you promised. Finally, analyze each sentence for proper placement and for proper spelling, punctuation and grammar. There is nothing worse than reading a professional’s report with spelling and grammar errors. Before you submit your final report, go back over your notes and the original letter from your attorney-client. What did the attorney ask for? Did you include this information? Make sure it’s all there in the final draft. - Send a cover email and confirm receipt of the report
If the report is comprehensive, be sure to include a cover email introducing the report. Restate your assignment briefly, summarize your bottom-line opinion and conclude by thanking the attorney-client and offering to provide additional CLNC services on this or future cases. Submit the report in PDF format and confirm the report has been received. CLNC consultant, Marcia Bell describes, “More than once, I have emailed a report and later received a call from the attorney requesting it. While I was able to forward the email proving that I met the deadline I’ve since become more diligent about confirming receipt of delivery.”
Your legal nurse consulting report will linger in the attorney’s office long after you submit it. It may travel to other attorneys within the firm and even to other law firms. What type of first (and sometimes, only) impression are you leaving with your attorney-clients and potential future clients? Make every report the best ever by implementing these 22 best practices.
Special thanks to the CLNC Pros: Suzanne Arragg, Dale Barnes, Marcia Bell, Shequita Moore and Lori Sprenger for sharing best practices for creating memorable legal nurse consulting reports.
Success Is Yours,
P.S. Comment and share your best practices for creating memorable legal nurse consulting reports.
