Back in October, I wrote a critical post about the American Medical Association Guide to Causation of Injuries, 2^nd edition. (AMA 2^nd for short) But as I revised that post to submit as a more formal article, I realized some of my criticisms of the AMA 2^nd were misplaced.

I still believe the AMA 2^nd will be used by the defense bar to informally heighten causation standards. Other bloggers have made similar observations about the use of the AMA 2nd.

I still believe the AMA 2^nd will be used in lobbying efforts by the insurance industry.

But after reviewing the AMA 2^nd in more detail, I think the danger of the AMA 2^nd is in the misuse rather than the use of the AMA Guides.

I came to my conclusion after reviewing materials written about the AMA 2nd by J. Mark Melhorn, MD who is one of the primary authors of the AMA 2^nd.

The AMA 2nd gives doctors guidance on how to determine causation for a work injury. How the AMA 2nd differs from a traditional differential diagnosis is that the Guides ask doctors to consider statistical studies concerning causation – or epidemiology – as to whether a condition is work-related. I think it is important to note that the AMA 2^nd still requires a doctor to consider work duties and other factors specific to the injured worker in determining whether an injury is work-related or not. The authors of the AMA 2^nd is clear about the limits of epidemiology. The authors of the AMA Causation Guides are also clear that medical causation and legal causation are different concepts.

Because of how the AMA Guides to Permanent Impairment, 6^th edition (AMA 6^th) for short, have hurt injured workers, I like most plaintiff’s lawyers have a visceral reaction to anything document that includes “AMA Guide” in the title. But if I am faced with a medical report or doctor stating that my client’s work duties could not have caused his or her injuries citing to the AMA 2^nd, the AMA 2^nd is likely being misinterpreted.

The term “evidence-based medicine” is another trigger for plaintiff’s attorneys. Evidence-based medicine is synonymous with the use of statistical research. While the defense bar seems to have marshalled the mystique of math to their advantage, a lot of time the numbers can work for employees. Plaintiffs can cite to favorable studies linking repetitive or overuse to musulo-skeletal conditions.

Epidemiology can also be helpful to workers in other ways. In cases litigated under the ADA employers will justify discrimination based on disability under the theory that a disability or medical condition can pose a direct threat to the safety or health of others. Epidemiology can help an employee prove their medical condition poses little or no risk to their safety or the safety of others. In my experience, this is particularly true if this research is shared with specialists who have treated the individual in the past.