This site uses cookies.

Short Notes on Psychological Injury 2018 - Dr Mark Burgin

25/05/18. Dr. Mark Burgin BM BCh (oxon) MRCGP considers the elements that should be included in a primer for clinical negligence cases involving Psychological injury.

There is a range of opinion with some experts believing that a psychiatric diagnosis is the injury, others that multiple symptoms are evidence of injury and others that any symptoms are evidence of injury.

Diagnosis based injury approach is too harsh as few previously normal claimants will develop a psychiatric diagnosis solely as a result of an injury.

Using symptom based injury system could cause public interest problems because there could be increasing numbers claims for minor symptoms with no associated loss or distress.

Alternatively the claimant may be overcompensated when for instance multiple symptoms including those that are pre-existing are assumed to be due to one cause and grouped into a single psychometric score.

Whatever methodology is used the claimant’s emotions, thoughts and behaviours should be linked with logical associations so that the court can consider each potential psychological injury (thread) separately.


Linked thoughts, emotions and behaviours (threads)

Individual symptoms do not confirm that an injury has occurred, for instance it would be considered normal to have a memory of the event or feel wary at the site of the accident.

GP experts will typically assess hundreds of psychological injuries per year using the biopsychosocial model and automatically link the symptoms into threads. (1)

An example of a thread is a panic feeling when driving associated with a thought ‘other drivers are rubbish’ and the behaviour of driving erratically to scare other drivers.

Making a pattern explicable can assist when the court is trying to determine whether a thread is likely to be related to the accident, to another specific cause or to an unknown cause.

It is assumed that post traumatic symptoms can only be due to the index accident so PTSD appears to be an easy diagnosis that cannot be challenged.


Range of opinion on PTSD

Post traumatic stress disorder criteria includes the following ‘exposed to death, threatened death, actual or threatened serious injury’. (2)

Patients with no compensation claim pending can develop intrusive thoughts after an event even where a reasonable person would not have seen a threat in that situation.

The expert should indicate the claimant’s reasons for thinking that the impact could have caused death or serious injury so that court can properly assess the thread.

An expert assessing a claim for PTSD based upon a mild side-swiping impact from a HGV that does little damage to the car must include a range of opinion to properly assist the court.

The range of opinion should include the possibility that the court may only accept part to the claimant’s symptoms as an injury or only part as due to the accident.


Separating the threads of psychological injuries

Ideally a report will give the court a series of threads together explaining the symptoms and linking them into distinct injuries.

There are three main problems when separating the threads of psychological injuries which are best dealt with common sense rather than technical argument.

The claimant states that two threads are linked when the expert’s opinion is that the threads are separate but it is difficult to achieve a consistent explanation if they are linked.

The experts disagree as to the number and extent of the threads and both points of view appear reasonable, this probably represents the range of opinion on the evidence available.

The expert’s description of the threads does not appear to make sense or seems overcomplex and incomplete, the expert themselves may be struggling to understand the case.


Conclusions

Linking psychological symptoms into a thread allows the court to examine the issue of whether the pattern is an injury but also gives strong evidence by linking the emotion and the loss.

Breaking the claimant’s symptoms into a series of threads assists the court by explaining the issues simply and clearly and allows the court to separate the issues in the case.

Using soft criteria for a PTSD diagnosis can potentially open the door to false claims unless the psychiatric report is supported by a range of opinion.

A primer on psychological injury should consider whether compensation should be allowed where the thought is unreasonable or the symptoms are a normal reaction.

Doctor Mark Burgin, BM BCh (oxon) MRCGP is on the General Practitioner Specialist Register.

Dr. Burgin can be contacted This email address is being protected from spambots. You need JavaScript enabled to view it. and 0845 331 3304 website drmarkburgin.co.uk

    1. Burgin 2016 How to Document a Biopsychosocial Assessment in Personal Injury www.pibriefupdate.com

    2. American Psychiatric Association DSM V: Diagnostic and Statistical Manual of Mental Disorders.

 

    Image ©iStockphoto.com/RapidEye