May 2009

Every Certified Legal Nurse Consultant knows that after a patient has a stroke, the care they receive in the first 3-4 hours is the most crucial. The type of stroke influences the treatment so proper recognition and diagnosis are essential. Despite this knowledge, the National Quality Forum (NQF) recently rejected a proposed guideline that would have called for a CT scan within 45 minutes of a patient presenting to the ED. Why is this important? The NQF sets the medical guidelines that are used by the Centers for Medicare & Medicaid Services (CMS) to evaluate (and reimburse) hospitals. So, with no reimbursement, the likelihood of a patient getting a CT scan drops pretty dramatically.

Hospitals receiving Medicare funding will soon be reporting how well they comply with guidelines for stroke treatment, even though one of the most important diagnostic tools for stroke (a CT scan) was not done.

The American Association of Neurology pushed strongly for the guideline and the American Stroke Association’s (ASA) guidelines for stroke care include the recommended 45-minute standard for scans. According to the ASA nearly 700,000 Americans incur a stroke annually, with 170,000 fatalities. In other words, an American suffers a stroke every 45 seconds and every 3 minutes, one of these stroke victims dies, so it’s very likely you’ll run into a case involving a stroke at some point in your legal nurse consulting career. As a CLNC^® consultant working on stroke cases, you should establish whether the standards of care for diagnosing and treating stroke were adhered to by the potential defendant hospital and healthcare providers. Establish not only whether or not a CT scan was done, but how timely it was ordered, completed and interpreted. Despite NQF, who looks like they had a stroke (not a stroke of genius) reputable testifying experts will be testifying in medical malpractice cases that a CT scan within 45 minutes of presenting to the ED is the standard of care.

Success Is Inside!

P.S.     Comment and share your vote on NQF’s decision.

Homes across the U.S. are smelling like rotten eggs. There’s actually a deeper reason than a teenage boy’s socks. Depending upon the age and location of the home, it may contain defective drywall. We’re all aware of the environmental problems and issues associated with China and its pollution, chemical spills and lead paint in children’s toys. But there are other ways that defective products can get into a home. One of which includes building or repairing the home with defective products (and the watchdog in this case is not the FDA)!

Between 2004 and 2007, millions of pounds of defective drywall were imported from China and used to build and repair homes in the U.S., especially in Florida (and 12 other states). The Chinese drywall in question contains large concentrations of sulfur compounds which, when exposed to humidity or moisture (like in Florida), emit sulfuric acid causing not only health problems but also damage to a home, its electrical wiring and its contents (human and otherwise).

Certified Legal Nurse Consultants screening cases in the concerned states that involve respiratory problems accompanied by persistent coughing, recurring headaches, nosebleeds and eye irritation might consider investigating whether the potential plaintiff(s) live in a home or building constructed or extensively repaired during that 2004-2007 period. Follow-up questions might include asking about a persistent rotten egg odor (smell of released sulfur), intermittent problems with electrical appliances or wiring (due to sulfuric acid exposure) and even whether the potential plaintiff has recently had to replace an air conditioning coil (new air conditioning coils should last in excess of 15 years). Jewelry and pennies turning black from corrosion is another possible indicator of exposure. The Consumer Product Safety Commission (CPSC) is investigating the problem and you can read a copy of their warning here.

Search the Internet for terms such as “Chinese drywall” to locate attorneys who are handling these cases. Legal nurse consultants should also pay attention to the news for reports on these cases and the attorneys associated with them.

Success Is Inside! (just stay outdoors),

Any legal nurse consultant who owns a computer running the wonderful Windows^® operating system (OS), has, at some point been faced with the little pop-up that tells you something to the effect that “high-priority updates are available for your computer, would you like to download and install them now?” My answer is a whole-heartedly qualified “Yes! I sure would in certain situations.”

I live behind a firewall, I’ve got eight real servers, a couple of virtual ones and any number of different “legacy” (geek-speak for older) programs running across 25+ computers at any given time. Before I can do an OS update or upgrade, I’ve got to make sure it doesn’t “break” anything (geek-speak for causing an older program to no longer run correctly) causing your users, then you, much pain and grief. This update/upgrade issue is compounded by our numerous websites designed to be viewed with various versions of any number of different browsers (Safari, Firefox, Internet Explorer, etc.) running different web services to collect and transfer data. So, when Windows asks me if I want to add a new service pack to my XP operating system, or high-priority updates to my Office programs or even to upgrade to a new level of Internet Explorer, I have to step back and think about it.

However, if I was a Certified Legal Nurse Consultant running Windows XP or Windows Vista and the Office family of productivity software (talk about an oxymoron!), I’d have a different answer. As an individual user not connected into any “legacy” software and whose system is working with existing printers, scanners, etc., I would install every service pack for Windows XP and Vista that comes down the line. Service packs are upgrades to the operating system itself and usually contain fixes for other issues that have arisen since the last service pack. They’re designed to cure deficiencies in the original program and make it into something safer and more stable than the prior version. In Windows XP’s case service pack support has been discontinued and only high-priority updates will be issued in the future. Service packs are a way to upgrade to a newer and better version of your operating system (keep your Vista service packed up). If you’re worried that an existing program won’t run correctly after a patch, do a Google search before you download and install the latest version to see if the new service pack is contraindicated for your software. If not, go ahead, download and install that sucker.

Even Apple offers OS upgrades (and patches) designed for the same purpose. According to an article in The New York Times, researchers at Symantec found 26 vulnerabilities in the Mac OS X in 2008 versus 27 for Windows Vista. The takeaway? No matter what OS you’re using – keep it current.

High-priority updates are different than service packs. High-priority updates are just that – fixes for something Microsoft has deemed a high-priority problem. Believe me, if Microsoft thinks it’s high-priority, it is (or was six months ago when it was identified and Microsoft started working on a patch [geek-speak for "emergency fix"] for the issue). Download and install high-priority updates. Always. Period. End of story. Your computer won’t be completely safe, they never are, but it will be as safe as can be as long as it’s fully patched and packed up.

How do you go about setting this up? There are a couple of ways. The easiest is to go into your Windows Control Panel (Start, Settings, Control Panel or Start, Control Panel depending upon what start menu you use) and adjust your Automatic Updates to download and install updates automatically. Then, every Wednesday night, or whatever time and date you set, your computer will contact Microsoft’s servers to check for updates and it will download and install the updates automatically. This is a great way for a CLNC^® consultant to keep his/her computer up-to-date.

If you don’t trust Microsoft to do this (and not everybody should), you can open Internet Explorer and go to windowsupdate.com and follow the instructions to check your computer against the lists of the most current service packs and updates. The computer will do so on its own, just give it permission to install the necessary applets and give it some time. Without releasing any private information to Microsoft, your computer will be checked and a list of “high-priority” and “available” updates will be generated for your computer. I usually select just the “high-priority updates” and then review the list to see what Microsoft feels is high-priority. You can deselect any that you don’t think you need, and then let the computer install them. Sometimes it takes a couple of reboots but I feel much safer afterwards.

If you have a company-issued computer or work for a company and access various programs through a virtual private network (VPN), you’ll want to check with the IT department to see what the company policies are on updates – automatic or otherwise – before you install anything. After all, you don’t want to be the one to “break” the system! Otherwise, if you’re using your own computer – go ahead and patch and pack it up!

Keep on techin’,

Tom

I am at the airport getting ready to leave for Paris with my Starbucks^® coffee in hand. After this long flight, I’ll be ready for that glass of red wine that always accompanies my Parisian breakfast. Click on the video to find out what legal nurse consulting, comprehensive reports for your attorney-clients and Paris have in common.

Success Is Inside!

I just got back from the Chicago CLNC^® 6-Day Certification Seminar and had to share the immediate success of one of my CLNC^® students. Watch this video from a brand new Certified Legal Nurse Consultant.

Success Is Inside!

Every day at our Chicago CLNC^® 6-Day Certification Seminar, the housekeeper left a handwritten thank-you note on my pillow. With that little note, she received a pay raise. The money I was leaving for a tip doubled after that second note. Her simple act of gratitude for a small gratuity led to a larger gratuity.

This week, make it your goal to send three handwritten, attitude-of-gratitude notes every day. Send thank-you notes to:

• Attorneys you’re currently consulting with.
• Anyone who has helped you get those attorney-clients.
• Inactive attorney-clients for their past business.
• Your CLNC^® subcontractors who have helped you on cases.
• Anyone else you can think of who helps to make your CLNC^® business easier to manage and more profitable.

This is a powerful marketing tool that will reap big rewards for Certified Legal Nurse Consultants and everyone else. Think about the last time you received a personalized, handwritten, thank-you note from someone. Didn’t it make much more of an impression on you than a thank-you email? In a world where technology rules, it’s the simple handwritten thank you that will stand out and stick in the recipient’s memory.

At the Institute we post all the handwritten thank-you notes and cards we receive on the bulletin board in our lunchroom. That way, all the staff can share not only the sentiments of the author, but also the pride the recipient feels in being recognized.

Handwritten notes are not only a great way to demonstrate how much you respect the professional relationship, but are also a great way to retie connections with attorney-clients, subcontractors and vendors. Your personal message reminds attorney-clients of the work you’ve done for them in the past and of the relationship that you share. Even a little 4-sentence note may open the door for additional business!

Every CLNC^® consultant should have a box of high-quality note cards. Embossed with the name of your legal nurse consulting business isn’t required, but go ahead and spend the extra money for good quality paper and presentation. It’ll be worth it.

Send thank-you notes for the next thirty days and watch your CLNC^® business soar along with your attitude of gratitude for all of the new cases you are receiving.

Success Is Inside!

P.S.	Discover 54 more free ways to promote yourself to attorneys.

From the beginning – let me disclose a conflict of interest, I’m a Firefox user. I’ve flirted with Apple’s Safari but find it is too slow to render its pages, and it’s got the worst search function ever designed for looking for text on a web page (although it does tell you how many matches there are on a page). I’ve customized my Firefox browser to include my favorite blogs, news and RSS feeds and, even though it’s a little slow to open the first time you fire it up each day, I love the fact that I’m tuned in to the world every time I jump on the Net. It’s great the way I can do tabbed browsing, with a simple right-click opening pages from my Yahoo! searches in a new tab so I’m not clicking forward and back to get to my search results after a page pans out. It’s also cool to be able to look up forgotten passwords for websites that deleted my “cookies.”

With my built-in bias, I downloaded and installed Internet Explorer (IE) 8. I’ve had IE7 installed for some time and have always found it a little clumsy. In fact, the only reason I have used it is to access the Windows^® Update website and keep my Windows XP OS and Office programs patched up. I didn’t like IE for general web surfing and had a latent fear of all its vulnerabilities I’m always reading about. Firefox seemed like the best way to practice “safe surfing.”

Now that Microsoft^® has released IE8, a number of Certified Legal Nurse Consultants have asked me whether or not they should upgrade. My answer is an unqualified “yes.” IE8 is probably the best version of the IE browser that Microsoft has released. It’s supposedly safer than ever and when you open a new tab, instead of seeing a blank page, you can choose to open previously closed tabs as well as other options. It offers a so-called smart address bar feature (that I’ve turned off in Firefox and dislike in Safari) that offers sites from your browser’s history as you type in an address. It also has better options within the “delete browsing history” function that gives you better control over what data (even website-specific data) you want to keep or delete.

When you click on the “x” to close an individual page, it asks you if you want to close all tabs or just one. There’s a new filtering service you can select which will display a warning page prior to visiting any site that is deemed to contain malware or that might be a phishing site (security risks). Something really cool is that IE8 highlights the core domain name of the website you’re visiting to help you avoid sound-a-like or typosquatting sites. To help make this a safer browser than previous versions of IE some other security improvements have been added. On the negative side, IE8 may not display all websites the way they’ve been designed to be viewed – not everyone will catch this – but it offers a “compatibility mode” that will allow you to see a website to view the “broken” site correctly and it will remember those sites for you, switching in and out of compatibility mode automatically.

In short, any legal nurse consultant that uses IE on a regular basis should upgrade to IE8 and then keep an eye out for upcoming patches. I also recommend that you make sure you have all the current high-priority Windows updates installed prior to moving to IE8. The upgrade process is easy to download and install. It kept almost all the customizations to my iGoogle homepage (including my cool theme), RSS feeds, etc. This is a definite upgrade that I’m sure I’ll come to appreciate the more I use it and so will you.

Keep on techin’,

Tom

Sometimes silence really is golden. Any negotiating coach will tell you that in a situation where one party to a negotiation makes an offer or statement and a period of silence sets in, the first party to talk or break that silence loses the point. Silence can be uncomfortable when you are talking to attorneys about your legal nurse consulting services, so how do you pull that off?

Let’s say you quote your legal nurse consulting fee and the attorney says “that’s expensive.” Pause, take a deep breath and visualize (without smiling) that attorney in the hospital wearing a hospital gown with his backside showing. For all you know he’s just thinking and processing out loud. 10 seconds, 20 seconds, a minute…your silence is a demonstration of your confidence in your status as a Certified Legal Nurse Consultant. Soon the attorney will get uncomfortable enough to break the silence and accept your fee (which is quite reasonable) or negotiate further.

Success Is Inside!

Two nights ago, Tom and I had dinner in a fairly chi-chi restaurant here in Chicago. It’s known for celebrity sightings, great food and décor. Tom and I tend to eat fairly early (I’m up at 4:00am and usually have two meals before most people eat lunch). We’re not so early that we get caught in the walker stampede as the 2-for-1 early birds make their exits, but we do sometimes bump into the last of the hobbling stragglers.

We went for dinner after a day of teaching at the CLNC^® 6-Day Certification Program. We were seated at our table and the waiter finally showed up and asked us what we wanted to drink. We had reviewed the menu (posted in the window) while waiting in line, and since we were short on time, we ordered our appetizers before he’d even brought the menus.

The waiter seemed put off by this. He came back with our drinks (Shirley Temple – with a cherry for Tom, healthy green tea – iced, unsweetened for me) and proceeded to tell us about the menu. “Chef Brutus recommends…shared appetizers for the table, followed by distressed green salads, overly large entrees, coffee, desserts to share and mignardes just when you think you’ve had enough.” He had his script down and launched into it as if he’d never seen us before. It seemed he’d forgotten that we’d already ordered appetizers!

I politely interrupted him to remind him that we’d already ordered appetizers and I wanted to learn the daily specials (instead of how Chef Brutus recommended we maximize our dining experience as well as our check). That seemed to jog his memory somewhat, but he skipped over the specials, a little disconcerted by our preempting him, and told us he’d be right back with our starters.

As in most restaurants, the tables were close enough that you could eat off the plate of the person next to you and I heard the woman next to me say she “would have loved the fried soft-shell crabs, but fried foods are sooo bad for you.” My ears were on it and I was all in. Being from New Orleans, the idea of sentencing a soft-shell crab or two to a quick, cornmeal-battered, deep-fat-fried death doesn’t bother me.

I wondered why our waiter hadn’t mentioned the crab, or any specials, and then I realized – it was because he couldn’t handle the script change. It had disconcerted him so much that he launched straight into let-me-get-your-starters mode forgetting to tell us about the specials. I asked the waiter about the soft-shell crab special when he returned to the table and he denied that they were offering such a dish. My guess was that he’d already put in our dinner order and was unwilling to retract it from the computer (plus I’m sure Chef Brutus was already personally mashing my potatoes).

Throughout dinner, this waiter’s service was less than stellar. Have you ever wanted to say to a waiter/waitress – “If you were in my ICU, ED, etc., and I gave you the same service you’re giving me, you’d end up in the perpetual care unit (a.k.a., “MetalSlab Ice Cold”), giving me the cold-stare, not the cold-face.” Well that’s exactly how I felt.

Needless to say when the bill came around, I was not into tipping-you-for-a-bad-job-at-dinner mode, but against my better judgment I left a slightly larger tip than I wanted to for the sake of the busboy who’d delivered great service.

In contrast, we dined last night in another Chicago restaurant and the waiter was all over us. I asked him if they had unsweetened tea and he said, “No ma’am. But I’ll make you some, if you’d like.” Wow – withering cross examination on the ripeness of the heirloom tomatoes. Simple requests for additional salad dressing were met with equal grace and he continued to score points throughout the meal. By the time the bill came I was pumping rounds into the tip gun.

As a Certified Legal Nurse Consultant are you sticking to your script instead of listening to, or anticipating your attorney-client’s needs? Still reciting your list of 30-plus CLNC^® services or focusing on the one or two that put a sparkle in the attorney’s eyes? Are you reactive or proactive with your attorney-clients? Do you wait for them to ask for an additional CLNC^® service or do you volunteer ways you can improve your work product? Ask yourself, if you were the attorney-client, how much would you tip yourself as a legal nurse consultant? Does your service rate a 10%, 15% or 25+% tip? What level of service do you provide, or at the least, look like you want to provide? If you were a restaurant, would you be 5-Star or 1-Rotten Tomato?

Legal nurse consultants practice in a service-oriented industry. If you’re not providing 5-star service (even to a 1-star attorney-client) you’re letting yourself, your CLNC^® business and the legal nurse consulting profession down. It’s our duty to give the best – in everything that we do. Next time you reach out to your attorney-clients – think about your most fantastic dining experience and try to provide a level of service that the attorney will remember and tell other attorneys about.

Success Is Inside!

Last year, Botox^®, a medication containing Botulinum Toxin A, was routinely injected into over 2.5 million Americans and generated $1.3 billion in sales. All this despite reports that Botox could cause symptoms similar to botulism, loss of bladder control, blurred vision, trouble breathing, swallowing and talking (not because of the size of those lips). Certified Legal Nurse Consultants working for plaintiff and defense firms should be aware that on April 30, 2009, the FDA issued a statement that all botulinum toxin products (including Botox and Botox Cosmetic) carry a black box label warning as well as a risk evaluation and mitigation strategy (REMS).

A black box is the strongest safety warning that a medication can carry and is so named for the black border that usually surrounds the text of the warning. These bold-faced labels carry risk information and are most often found on medications that have a probability of serious or life-threatening side effects. When combined with the REMS, their purpose is to alert healthcare professionals prescribing or dispensing the medication, as well as the patients receiving it, to health issues and dangers associated with its use. Botox, Botox Cosmetic, Myobloc^® and Dysport^® will all carry the FDA warning. Consumers experiencing serious adverse events (med-speak for side effects) from use of any of those products can report them to the FDA online as part of the FDA’s MedWatch Adverse Event Reporting program.

While the placement of a warning on the box does not free the manufacturer or healthcare professional from liability for damages caused by the product, it may give rise to an assumption-of-the-risk defense in certain cases. Botox and its kin are not used solely for cosmetic purposes. They do have some legitimate medical applications (treatment of cerebral palsy and cervical dystonia). I’ve always felt that we can’t insert or inject a foreign substance into our bodies without expecting some sort of side effect. So the next time a friend or relative tells you they’re considering the cosmetic use of Botulinum Toxin A to reduce wrinkles or to stop sweating, the savvy legal nurse consultant should tell them to consider that they’ve been warned.

Success Is Inside (naturally)!