Calm down and take a big breath .. you are not on trial .. although it seems like you are, First, did you get my e-mail with pages from my book about PI? If not let me know. By the way .. I gave a great class this morning on doing workshops. The second hour of class was an actual workshop with various closes (methods to get people into the office) .. it proved to me that to be successful .. not matter if you have been in practice a week or 20 years .. all it takes is a little guts and skill and the ability to open your mouth .. the rest will follows. Getting back to the deposition. First .. call the attorney who is deposing you (probably your patients .. it¼s important to know who) if it¼s the patient¼s attorney be sure to meet with them for a few minutes prior to the actual deposition .. this is common practice and not deceptive. During this meeting .. ask them to show you his/her qualifying questions .. usually they will be from a standard form they carry around .. used mainly for MD¼s. If there are questions like which medical school did you graduate from .. are you a member of the AMA? (your answer should always be you never applied .. well doctor isn¼t it true that chiropractors are not in the AMA .. your reply would be .. I¼m not sure) .. are you board certified (yes you are .. at least the national boards) .. are you on staff with any hospital (no .. I never joined .. if they pursue the question just say that chiropractors throughout the country are on staff on hospitals but you never applied to join) these questions may be what is asked from the other side .. but your attorney will have these on their list as standard fare. The purpose of this short outburst of qualifying and disqualify questions is used by the attorney to make you either look like an expert or not. Don¼t get uptight .. they are standard questions and if you do a decent job up front with these they see you are cool and the deposition will be shorter than you think. If the questions are not to your liking .. let them know .. they will make notes and ask you others .. such as what is chiropractic .. make it simple .. „chiropractors relate structure to function .. there are 26 bones of the human spine protecting the spinal cord as it travels down the back. If the muscles and ligaments that support the spine is aggravated and has to defend itself .. such as in a typical hyperextension hyperflexion injury .. a whiplash .. spasms and instability results. The length of time for stabilization and rehabilitation of the injured area depends on the ability of the spine to adapt. As a chiropractor, I biomechanically evaluate the patient¼s spine and recommend a protocol of care called adjustments .. along with adjunctive therapy (if you use any) to assist the body in regaining its lost integrity.¾ If they ask you to describe nerve insertion and origins (which they wont) and you are not clear of the answer .. say this .. „I cannot at this point provide you with the specific area .. but as part of my training, I have reference sources that enable me to be as specific as necessary.¾ If they ask you if you are duplicating the care of the medics .. especially the orthopedist .. your answer is simple: „The only duplication would be in the examination .. but the method of care is totally different.¾ If they ask you to describe an adjustment .. „it is an applied force to a fixated area of the spine to assist in normal mobility .. there are many methods of chiropractic care.¾ If they ask you to describe an examination procedure that is medical .. such as an MRI .. CT scan or medical EMG and you are not clear on exactly what it does .. be general. „I am aware of the procedure, but haven¼t had the opportunity to use it .. or it isn¼t within the scope of the chiropractic practice¾ If they ask you why you saw the patient so long (remember .. to them anything more than two visits is too long) be general again: „Chiropractic care is a physical method of healthcare. It is necessary to first stabilize the patient¼s condition .. if the problem is from a trauma such as an auto related collision .. it may take longer. Patient¼s usually come daily or a number of days per week and receive their adjustment as well as some lifestyle changes such as exercises. The treatment schedule is dependent on the response of the patient.¾ If they ask you how you established your fees tell them: „these are the prevailing fees for chiropractic care in the area.¾ During the pre-deposition meeting with your patient¼s attorney discuss if there are questions about the patient¼s care .. if they will be focusing on any specific areas .. if you feel uncomfortable with these areas .. let them know and come up with some degree of answers. If there were gaps in treatment the attorney should know and if you know why tell them .. if the x-rays were not of good quality tell them so they don¼t ask you if you even have them .. if there are specific areas that you feel they should be aware of .. either to make their case tighter or something to be concerned about .. now is the time to let them know. As far as the vitae .. if you have a recent Palmer catalog use the hours the have as what you studied. I am sending below this mine .. use the same hours it is out of the Life catalog .. it¼s probably the same .. they¼ll not be concerned where you received it. Place your pre-chiropractic education and any other items that you have been certified in. In the beginning you sit next to a court stenographer and raise your hand to swear in. Your attorney will ask if you wish to waive your rights .. I normally do .. The rights are to view your testimony before it is officially printed .. you cannot make any changes .. so I normally waive the rights (I may ask to court reporter if he/she can send you a copy .. they normally do) Once you are sworn in .. your attorney (or the one that has deposed you) will qualify you as an expert .. state your name .. your address or at the time of the treatment of the patient) .. where you went to school .. (I always present my vitae before the depo begins .. both attorney get a copy) where and when you graduated (these are the qualifying questions I discussed above .. the other attorney may come back and ask about the AMA .. hospitals .. or if you are licensed to prescribe medicine .. again your answer is „it is not within the scope of chiropractic practice) If your attorney (patient¼s) feels this has placed you in a negative light .. he/she may re-question you to expand your answers .. When you answer questions .. especially from the other side .. make them brief and simple .. yes/no .. just to the point. Remember the more you put your foot in your mouth the harder it is to get rid of. The your attorney will ask you if you ever had the opportunity to meet and treat the patient. Answer yes .. when and for what reason ..tell them .. can you describe your findings. Here I read my narrative which was completed well early on in their care. The attorney may ask you if you came up with an diagnosis .. my answers are always simple .. „the patient experienced a hyperflexion and extension cervical injury with an accompanying sprain/strain to the cervical, thoracic and lumbar spine. This when the neck and neck is forced forwards and backwards producing an overstretching of the soft tissue component that supports the spine .. the muscles and ligaments. The muscles allow mobility and when injured produce a strain. The ligaments are stabilizing units and when over stretched and aggravated produce a sprain .. this results in acute spasms or a gross defensive posture of stiffness and lack of mobility.¾ Did you have the occasion to exam the patient .. yes .. and your findings were: „The patient was evaluated in all areas of the spine. I found the range of motion within the neck to be below what would be considered normal. Normal flexion .. or placing the chin against the chest is 60 degrees but in this patient¼s case it was 35 degrees and she was in pain. ..etc. I palpated .. or ran my fingers down the patient¼s spine and felt areas of spasms with trigger points that were guarding the area. There were other tests that were positive .. meaning there were other objective findings (they may ask you to describe the difference between objective and subjective. As you know .. subjective is what the patient tells you .. objective you arrive your conclusions alone .. all your tests were as objective as possible .. if the other attorney is an ass .. he/she may ask if it¼s not true that your objective findings could have been subjective .. like a patient not flexing their head enough or telling you it hurts when it didn¼t .. your response is „I was objective as I could be.¾ Then they may go over any notes you have .. day to day visits ..why you used this or that .. what instructions you gave them .. did you refer them out .. if not why not .. „I didn¼t feel the need to refer this patient to a medical physician .. if I did I would have .. I have no problem doing so and have had a fine relationship with the medical community (whether you do or not).¾ The other attorney will be taking notes and looking through pages of notes (most have nothing to do with you) .. and then begin his cross examination. He will go over certain dates .. possibly the examination and charges .. never get flustered or spooked .. they wish you will. Be calm and think that the opposing attorney is actually your patient¼s and try to answer accordingly. If you are unclear of an answer simply say ..¾I¼m not sure or I don¼t know.¾ If they ask you why you did this or that or didn¼t do this or that .. simply say .. „it¼s not part of my treatment protocol.¾ If they ask you why you saw the patient so long .. charged them such a large fee .. or whatever .. you answer is always the same: „This is the care I felt this patient needed and she was cared for accordingly.¾ Try to read this a few times .. depositions are the same all over .. it is a matter of discovery .. what you know and don¼t know. Just another day in the life of an attorney .. they are not out to get you .. just to get through and usually in an hour. Take a deep breath and relax ... Dr. M PS ..now to your specific questions: Brachial involvement „The lower portion of thr cervical spine .. the junction between the neck and upper backis called the brachial plexus .. plexus meaning a group of nerves. If there is interfrnec with the flow of nerve energy from this area it can affect the patient either with a sensory impairment .. pain .. numbness .. loss of strength .. heat or cold .. etc. It also has a functional portion that affects the peformance of the body. Any trauma to the neck and shoulders .. possibly which is the case of a half nelson .. tension and torsion of the skull and pressure to this portion of the neck .. can produce a defensive posturing with resulting reactive spasm and instability. Portions of this nerve distribution is the axillary nerve ..which fees into the shoulder girdle. This possibly was aggravated producing this patints symptoms.¾ As far as nerve conduction studies and EMG .. if you didn¼t do them .. you are not responsible for the interpretation and your answer is: „I didn¼t perform this procedure .. I would recommend you ask the physician for their analysis .. or I am aware of these test .. but the interpretation I leave to the doctor that performed the test.¾ Doctor wouldn¼t it be important that you are aware of these findings? Your answer is: „Yes .. they are a piece of the puzzle to assist this patient .. but my chiropractic evaluation and analysis .. performed each visit .. assists me more.¾ „Often a dislocated shoulder is a mechanical problem that may or may not involve specific nerve fibers .. more muscles, ligaments etc. If the area was aggravated enough to produce instability and a guarding of muscles to the point of chronic (long term) spasms .. it could very easily produce irritation to brachial region at which time pressure upon the nerve fibers is possible resulting in a delayed reaction and symptomotology. The negative EMG is not unusual .. as it is detecting muscle reaction to stimulus and attempting to objectively see is their is nerve damage. Often these tests are negative but the patient continues to suffer with pain.¾ In terms of tears and resulting physical problems .. I can¼t give you a good answer .. if I were put on the spot I would say: „Anything is possible when the body is traumatized .. as it was in this incident .. it reacted as best it could .. in this case producing the weakness and pain the patient seems to experience. As far as the long thoracic nerve and what it does .. they¼re not going to ask .. but this is important to you .. so did it up in an anatomy book. Whether it is motor or sensory??? I¼m not sure what you mean by a winged scapular .. if the structure is an anomaly or transitional .. then it is possible it is structurally weaker or stronger .. and therefore can produce a reaction upon insult and trauma .. twisting the neck .. cervical pressure is trauma. I do not describe the five components of the subluxation in my depos .. in fact I keep the word out is possible. This is not meant to defame or ignore chiropractic terminology .. it is to reduce the time involved explaining it. It is my opinion that a deposition is not the time for a lay lecture .. get in and get out. While in court before a live audience .. it is time. A Subluxation is the Chiropractic definition of nerve root pressure. Subluxations have five components and took time to develop and will take time to correct Kinesiopathology (abnormal motion or position of spinal bones) Neuropathophysiology (abnormal nervous system function) Myopathology (abnormal muscle function) Histopathology (abnormal soft tissue function) Pathophysiology (abnormal function of the spine and body)