approach

Follow the evidence. Explain the reasoning.

A letter to attorneys from Jeremy Gomer, MD, PhD.

I am very grateful to you for considering me for your medical-legal evaluation. My commitment to you is to adhere to the highest ethical standards in performing my evaluations. Medical-legal cases can be very contentious. I appreciate that attorneys are busy professionals, and the last thing they need is more work added to their plate due to a poorly written medical-legal report. Most doctors forget that depositions don't happen because attorneys are trying to torture a physician, but because of incomplete or unclear information in a medical report.

Some medical-legal evaluators make the mistake of trying to make both sides happy in a poor or unethical manner. Some favor one side or another due to their default way of thinking. But our job is to follow the law and use objective standards of evaluation. What is my philosophy for serving a highly contentious matter fairly? To explain my reasoning in detail.

It is often frustrating, from an attorney's perspective, to read conclusions in a report with no reasoning, or poorly explained reasoning. Though I am an internal medicine physician and my main job is to be a primary care doctor to my patients, I still carry my philosophical training. My academic background is in philosophy. In philosophy you must always give your reasoning — and reason well. It would be inappropriate to advance a conclusion without a tightly reasoned argument. In this way, my fellow attorney, I am like you: the field of law depends on putting together tight arguments and reasoning your way to a conclusion, not inserting it without context. When I handle your evaluation, you have both my medical and philosophical sides working through your case.

— Jeremy Gomer, MD, PhD

The standard I hold myself to.

I actually read attorney cover letters

I read through and note what was actually requested. It is poor practice to assume every case has the same request or goal. I never make that assumption.

I actually write and compose my own report

My reasoning and conclusions come entirely from me. I don't use ghost-writers or even an editor — I proofread my own typos. Medical reasoning has to come straight from the doctor.

I actually use the medical records to build an argument

Is a condition industrially related? How do we apportion a pre-existing condition potentially worsened by a workplace injury? I trace the issue through prior records and its evolution over time, and my reports discuss that prior record.

I answer the questions within the scope of my specialty

Internal medicine encompasses cardiology, gastroenterology, endocrinology, rheumatology, nephrology, pulmonology, infectious disease, oncology, hematology, and sleep medicine. I won't issue an unwarranted opinion outside my specialty, such as surgical fields.

I actually use the AMA Guides

The AMA Guides exist so there is an objective reference standard. I frequently refer to their tables, criteria, and examples so my reasoning reflects the standards set forth in the Guides.

I provide clear, actionable recommendations

Do we need further labs, imaging, records, or consultations? They're listed in every report, every time, with the reasoning laid out in detail.