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LNCtips.com: Details vs. Minutiae


Legal nurse consultants know that details are important in the analysis of medical malpractice cases.  However, new LNCs often mistake minutiae, those small trivial facts, for important details.  How can new LNCs tell the difference between details and minutiae?  Let me tell you. 

The answer is easy.  Except for demographic data, it's a detail if it's information that's meaningful to the case.  A minutia isn't relevant to the case.  I think that new LNCs have so much difficulty with this concept for three reasons:

1) The same information can be meaningful in some cases but useless in others.  For example, the fact that a patient has normal bowel movements may be irrelevant (and therefore minutia) in a case involving a fractured humerus.  That same information may be an important detail in a case involving colon cancer.

2) Nurses love the medical aspects of the case.  After all, we're trained to perform patient head-to-toe assessments on a regular basis.  Nurses are comfortable with medical information and want to learn more about it.  It's hard to wrap our heads around the fact that not all medical information is important in a legal case.  However, interesting information doesn't necessarily equal important information in a legal case.

3) Some LNCs review the case solely based on their medical knowledge.  They seem to forget that they need to review the case in terms of duty, breach of duty, patient injury, and causation as well.

What's the solution to differentiating details from minutiae?  As a new LNC, you can do a focused analysis.  An even simpler solution is to write down what you're going to look for in a particular set of records.  For example, let's look at a case in which the patient has a loss of function in her hand allegedly due to IV infiltration of a toxic medication. 

* You'll look for the actions (or inactions) of the staff who inserted the IV and cared for the patient after the IV was inserted.  You'll also review the medication orders and administration of medications.  You'll determine how and when the patient's loss of hand function occurred.  This is the meat of the case, where you'll focus on standards of care, damages, and causation.

* When you review records prior to the incident, look at them from the standpoint of the patient's condition and hand function.  Did she have a history of venous problems?  Did she have any problems with her hand prior to the incident?  Did she ever receive OT or PT?  You're looking for the baseline function of her hand.

* When you review records for dates after the incident, you'll focus on the patient's continued hand function.  Did it improve, get worse, or stay the same?  Medical records from PT, OT, vascular physicians, and Neurology are particularly important.  You're looking for damages.  You're also trying to determine whether the patient's condition has changed since the time of the original incident.

Did you notice that we focused only on the things that were significant for this particular case?  By identifying beforehand the important types of information, we've been able to distinguish between details and minutiae.

Want to learn more about LNC skills for legal nurse consultants?  Check out the Archives.

...Katy Jones