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Why is there so rarely a TBI diagnosis for car crash victims who have TBI?

July 26, 2018 by Steven M. Gursten

Doctors fail to make a TBI diagnosis because, as a recent study shows, they’re not asking the right questions and they interrupt too soon and too much 

Why is TBI diagnosis so rare with crash victims suffering TBI? Study suggests one reason may be doctors' patient interviews

When I talk to lawyers about handling TBI cases, I include as part of my presentation two studies that show that emergency rooms fail to make a proper TBI diagnosis between 56%-80% of the time.

Having litigated these cases and having helped many car accident victims who have survived a traumatic brain injury from a car crash, I know first-hand how aggressively these cases are defended by the insurance companies when doctors fail to make a timely TBI diagnosis.

This failure also exposes a TBI victim to unnecessary delays in medical treatment and far too often it results in a complete lack of medical care and treatment for the brain injury.

There are many reasons for why a TBI victim’s brain injury goes undiagnosed or misdiagnosed, but a recent study highlights a new reason that has received very little attention until now: How medical providers talk to their patients.

Or, rather, how quickly doctors interrupt a patient.

In the study, “Eliciting the Patient’s Agenda – Secondary Analysis of Recorded Clinical Encounters,” researchers have concluded:

  • “Clinicians seldom elicit the patient’s agenda [“concerns and expectations”]; when they do, they interrupt patients sooner than previously reported. Physicians in specialty care elicited the patient’s agenda less often compared to physicians in primary care. Failure to elicit the patient’s agenda reduces the chance that clinicians will orient the priorities of a clinical encounter toward specific aspects that matter to each patient.”
  • “[I]nterruptions occur extremely early in the patient’s discourse and that patients are given just a few seconds to tell their story … [I]t seems rather unlikely that an interruption, even to clarify or focus, could be beneficial at such an early stage in the encounter.”

This study has very clear implications for why so many TBI survivors, especially those injured in a car crash, are not having their symptoms properly documented and diagnosed. In turn, this failure to document a TBI diagnosis is causing tremendous problems for these people in litigation in how the insurance companies evaluate and defend these cases for settlement. The failure to properly make a TBI diagnosis can also cause juries to discount the brain injury and to turn these car accident victims away at trial. Jurors believe that doctors are going to properly diagnose something and hold it against the injured patient when they don’t accurately document and diagnose an injury.

With doctors failing to elicit pertinent information and/or interrupting their patients’ explanations, medical providers are setting up TBI survivors for failure because, by the very nature of the traumatic brain injury, these people are already struggling with slowed processing speed, impaired recall, and difficulty with prioritizing concerns.  Many also have very real physical problems, because after all they were hit by a car or a truck, and this can cause very real but less obvious problems, such as brain injury, to be overlooked.

Not only does this study highlight the need for changing doctor/patient interactions, but it also reinforces the urgency of having patient advocates or other people present to make sure doctors are aware of all the problems that people are having.

Before they are interrupted.

The importance of making a proper TBI diagnosis in a car accident case

Getting the TBI diagnosis right in car accident cases is critical. It’s hard to believe so many are missed by hospitals and doctors considering how common they are. Car crashes are the “third overall leading cause of TBI-related ER visits, hospitalizations, and deaths,” according to the most recent data available from the Centers for Disease Control and Prevention.

And, as stated above, there are studies showing that doctors and hospital emergency rooms routinely miss and, thus, fail to diagnose traumatic brain injuries up to 80 percent of the time.

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