Apportionment
This is an area, to put it politely, is dreaded by most caregivers, double for those whose formal academic training is not in neuromusculoskeletal (injuries to the skeleton as compared to a disease-see the section covering caregiver’s qualifications) injuries! There are 2 scenarios that are common in this area. The first is when you, the patient, have been in a rear-impact collision months or weeks earlier and then you get into a second one. The other is when you’re being treated for a neck injury (related or not to an earlier rear-impact collision) at the time that you are involved in a rear-impact collision.
Allow me to give you an idea of just how bad it is out there, or at least in my little world of Victoria, B.C. Just ask your primary caregiver, i.e. the person caring for you injury(s) you sustained in the motor vehicle collision (MVC), how they plan on apportioning your present level of pain and disability. For fear of not being too blunt don’t be surprised if you get asked “what’s that?”
Said difficulty is made worse or easier all starting with the caregivers clinical notes (everything they write down about you in your chart). Remember the big picture is the caregiver is simply trying to determine what percentage of your present level of pain and disability is due to the first collision and how much to the second collision. It gets even more interesting when one of them was a front-end MVC and the other was to the rear of your vehicle. Want more, throw in a second complaint of low back pain and compound it by the complaint (i.e. neck pain) that was the worst at the start of treatment is a secondary complaint and the initial secondary complaint (i.e. low back pain) is now the primary complaint.
For starters it’s important that you understand, for the most part, we can’t measure pain objectively (i.e. such as with a CT Scanner, MRI, X-rays, etc). That said, by converting your subjective (how you describe pain and disability) into a number allows for conversion of your pain and disability into a numerical value that actually means something to a third party (i.e. judge, insurance representative, etc.).
There are only 2 areas to focus on; Frequency and Severity. Frequency means over the entire length of a day what percentage of it do you experience the pain. Severity means how much it’s actually affecting your daily activities.
Frequency:
0.25=Intermittent, 25% or less of a day.
0.50=Occasional, about 50% of a day.
0.75=Frequent, about 75% of a day.
1.00=Constant, 100% of a day
Severity:
1.00=Minimal, pain/discomfort is annoying/noticeable but does not limit your daily home and or work activities.
2.00=Mild, the pain causes only slightly/noticeably limits your activities.
3.00=Moderate, the pain markedly affects your daily activities.
4.00=Severe, prevents you from engaging in your home and or work activities.
Before we start to get into how we work a bit of math, with the above referenced numbers, remember it all starts out with how your caregiver(s) record your office visits in their clinical notes. If they ask you “how are you feeling?” and you respond “It hurts” v. “I’m fine” and that is exactly what they record in the notes without clarifying then they are going to have trouble with apportionment.
Typically when I chart my interactions with my patients I try and be precise enough to allow for apportionment should it ever be required, even years later. So when I ask “How has your neck been feeling since I last saw you?” If you respond “sore” I’ll typically follow-up with “Do you have to stop or alter any activities?” and if you answer “No” then it would be charted as ‘1 severity’. If I ask you “how often it affects your day” and you respond “a bit” I will typically ask “1/4 -1/2, etc.” and you respond “1/4” then I chart the work Intermittent. Some of you out there might be asking yourself ‘you do that every day, day in day out, for years? My answer is yes, fact is it’s almost too easy especially when I get a lawyers letter out of the blue, regarding a patient I have not seen for months or years and I have to describe their condition the last time I had treated them.
Here’s how it works; neck pain was 1 (minimal) severity and only experienced on an Intermittent (0.25) basis pre-collision -> 1.00 X 0.25=0.25.
Some months after the rear-impact collision it is required that the caregiver report on your present day level of pain/disability; 2.00 X 0.50=1.00
The end result is 0.25/1.00=0.25. In other works 75% of your present level of symptoms and disability can be contributed to the MVC.
So if those involved with your case are trying to apportion your injuries and the above formula is not being utilized you might want to ask exactly how they’re doing it. This topic is covered in much greater depth in my Whiplash Classes.