Pearls of Wisdom

Perseverance and Fortitude:
Necessary elements of a new LNC

by Rosale Lobo


     The world of legal nurse consulting has so many facets that it is difficult to really understand what it’s all about, until you are knee deep. If you can recall when you were allowed to practice as a new RN, you had your license, but really didn’t have a grasp on your role. Being an LNC is no different. There are many hurdles to jump. Perseverance and fortitude are the only way I have survived after all this time. The lesson: enjoy the journey.

     Back in 2003, when I began practicing as an LNC, I used many of the marketing tools available. I attended and exhibited at attorney conferences, I used print ads to market my company and of course I set up a web site. Making cold calls was not easy, but I did that too. With each cold call, I would stop at the neighborhood grocery or bakery so that I would be able to break the ice with the front office staff. Did this work for me? Sometimes.

      I practiced being rejected, because as a new LNC, there just might be rejection. This feeling could happen whether you are in house or independent. I practiced my elevator speech and put myself anywhere that I thought attorneys might be. All this got me closer to the goal of being a working LNC.

      But what other things can you do to get noticed by lawyers? Lawyers love to read good pieces of prose. While you are making roadways to get noticed by lawyers, develop strong writing skills. Find a topic of interest and write about it. Find pieces in the local paper and write a commentary. Start a blog page or follow an attorney that is of interest to you. Get noticed by putting yourself in front of them in a literal way. I wrote commentaries, assisted with a novel and submitted pieces to local publications. Just because I wanted more items on my CV other than the places I worked as a clinician.

     I can recall being a speaker for the first time, I was very nervous, but figured that it would advance my LNC career. All the time looking to build a CV that would demonstrate that I am a nurse who can research, write, and present on issues to support a point. You cannot show fear!

     Embrace all of the intellectual skills that you have. Work on your sample work products, research standards of care, ask a lot of questions of other LNC’s and keep in mind that you are to present yourself as a finished product, not one in the making. They are never to know that you are a novice, until you have established a relationship with them. Once your strengths are recognized, the rest will be easier. Enjoy the journey.

Narrative Report versus Chronology:
Which works best and when?

By Laura Grossman Nissim

     In my practice as an in-house LNC at a defense law firm, I have had to write many extensive narrative reports about Plaintiff medical issues and their histories. I am frequently involved with personal injury and product liability files, rather than medical malpractice litigation. Many of the cases I review are those of Plaintiff’s with long complicated histories and multiple complaints which may (or may not) be directly related to the claimed injury. If at all possible, our attorneys present the case to the LNC with as much lead time to generate the report as possible; often it is many years after the actual alleged injury and the documentation is voluminous. In those cases, I have the luxury of creating a narrative report that is supported by footnotes with definitions and pictures to help the attorney really understand the injuries and the interaction of the claims with the mechanism of those injuries.

     But there are also frequent circumstances where our firm receives the file at (truly) the 11thhour. Potentially on the eve of trial (when we can’t obtain any more discovery or identify additional experts) or on the eve of an EBT (examination before trial; aka deposition).  We may have been supervising the file, or the client has decided to pull it from the original firm litigating the case. In these cases, the attorney doesn’t have the luxury or the time to spend truly learning the medical issues. They are in need of concise, concrete information: the history of the Plaintiff’s injuries, his treating physicians, the frequency of visits and often the exact sequencing of events which had occurred both prior to the time of the injury and subsequent to it. In these circumstances use of a ‘Word’ table with columns provides a better educative tool. The table might include four columns with the following:

  • identifying date
  • location of service or MD
  • discussion or outcome
  • significant issues that need to be addressed

     Both methods of documentation of the Plaintiff’s injuries are effective, depending on the circumstances.

Managing Voluminous Medical Records

By Julie Dickinson

       The first time you receive a case that involves medical records delivered in boxes (yes, boxes), you will experience an incredulous amazement and ask yourself how it is possible that one patient can generate so many records.  This astonishment will soon give way to feeling utterly overwhelmed by the sheer volume of records.  How can you possibly organize all these records?  How will you ever be able to review them all?  The simple answer is page by page.

       During my first two years as an in-house LNC, I had several cases in which the medical records consumed 10 extra large three-ring binders, literally thousands of pages.  Additionally, there were countless cases in which the medical records comprised 3 to 6 extra large three-ring binders.  In-house organization of records is typically performed according to attorney preference, and, in my firm, the records are placed in chronological order by provider and/or hospitalization.  Each of these is then subdivided by tabs that resemble a hospital chart (e.g. physician orders, progress notes, laboratory results, radiology reports, consultations, etc.)

       I have found that the easiest way to organize high-volume records is to take the medical records from one provider or one hospitalization and set everything else aside.  Take this one set of records and separate the pages according to the sub-tabs, putting all the progress notes in one pile, all EKGs in another, all lab reports in a third pile, etc., until the original pile is completely dispersed.  Then focus on just one subdivided pile and organize those into chronological order.  Take the next pile and do the same.  Continue until that provider’s records or those hospitalization records are entirely organized.  Great job – you’re making progress!  Move on to the next provider, setting everything else aside, and repeat this process.

       This step-by-step approach breaks down the organization of voluminous medical records into manageable pieces and helps to avoid paralysis by shifting the focus away from the overwhelming whole.  Once the organization is completed and you are ready to review and analyze these lengthy records, I recommend using the same strategy as above:  provider by provider, section by section, page by page.