A survey of medico-legal practice patterns among pain specialists

Pain clinicians are increasingly asked to provide expert commentary in a variety of medico-legal or forensic contexts. The purpose of this study was to discover the frequency and type of medico-legal activity undertaken by pain specialists, their familiarity with current guidelines, and their opinions with respect to a need for formal ethical or practice guidelines.

Members of the New England Pain Association were surveyed with a 20-item questionnaire addressing specific areas of practice including the completion of disability forms, letters/attorney reports, depositions, testimony in court, record reviews, and return-to-work forms. Respondents also were asked to distinguish medico-legal activities for their patients from those that occurred for third parties.

Participants included pain specialists from a range of disciplines represented by the membership of a regional pain society. The response rate was 67%, with a total of 144 returned surveys.

Survey data revealed that 72% of pain specialists had engaged in some form of medico-legal work within the past year. Of those who engaged in this work, 96% completed this work as a treating clinician for their patients. While the majority of respondents engaged in activities such as the completion of disability forms, other high frequency activities included depositions and testimony. Differences between physicians and nonphysicians also were noted. Results revealed that the majority of pain specialists supported the development of guidelines for medico-legal practice. It was suggested that pain societies move to develop ethical and/or clinical practice guidelines to address this issue.