Some DME neurologists who render opinions on brain injury cases have no clue as to the inner workings of the brain. They believe it’s enough that they are doctors. Guess what. Things have changed since you graduated in 1962. And you haven’t made an effort to keep up and learn the science so you shouldn’t be giving opinions on lack of brain damage.They don’t know published classifications for brain injury severity.They still believe the Glascow Coma Scale predicts brain damage. Well, Natasha Richardson was coherent and appeared fine just before she died from a brain injury so, clearly the old way of thinking is wrong.
Do not fear asking about the science.
What is the apoe allele?
Does the brain go into hyper or hypo-metabolism after injury?
Draw me a brain cell (Believe me, when one doctor described it as an “umbrella” or a “Left shoe” even I was amazed at the depth of ignorance.
Which is heavier, grey or white matter of the brain?
Describe a brain injury to me on a cellular level.
Bad DME’s don’t know the science and are too lazy to learn it.
This is your backyard, not theirs. Why? Because when you try a TBI case, you learn the science and the medicine and probably know it better than they do.
When they go down the “it’s only mild and should be healed by now” road, show them the studies to the contrary. For example:
“Doctor, are you aware of the actual published statistics on depression due to “mild” traumatic brain injury?
“No”
“Before you claim some other cause of the spontaneously developed depression right after brain trauma, might you want to know the probabilities?”
(Either way he loses. Either he says “no” and looks like he doesn’t want to keep up with the science or facts or he admits he doesn’t ‘have the background to make the conclusion)
“What are the odds of a 42 year old man spontaneously developing depression vs it being due to a brain injury? Let’s look at probabilities. If the DSM tells us that men have a risk of developing Major Depressive Disorder in 5- l0% of the population. [i] If you then say my client has been alive as an adult 7,665 days and his life expectancy is 30 more years or 10,950 more days and there is a 5-l0% chance over the sum total of his life as an adult (l8,675 days) that he will develop Major Depression, then over l8675 days there is a 5-l0% chance of developing this, correct? So, if we take the days of his adult life and divide the potential by those days, on any given day he has a l in l86,l50 chance of developing depression at most.
Since my client experienced depression immediately after the accident, and we know that even mild TBI increases the risk of depression such that there is an l8% probability of developing a psychiatric diagnosis within l year post injury,[ii] that means on a given day post injury my client has a l in 15 chance of developing a psychiatric disorder due to a brain injury. (365 divided by 24) Then, there is a l in l86,l50 chance my client randomly develops major depression vs a l in l5 chance it’s due to a traumatic brain injury, right? That means that the brain injury is l2,4l0 times more likely to be the cause, right?
[i] DSM, 4
th 3d, tr, APA, page 372
[ii] Levin, H, McCauley, S et cal, Predicting Depression Following Mild Traumatic Brain Injury, Arch Gen Psych/vol 62, May 2005 at 523.