Abstract
Clinical practice always necessitates proper diagnosis and correct treatment. For most clinical fields, determining the cause of the illness is irrelevant to the intervention. An oncologist, for example, has no need to explore the “cause” of the patient’s lymphoma. Allergists, by contrast, have tools and the need to examine the relevant allergen which is the putative “cause” of the patient’s allergic symptomatology. In the context of a legal claim, the “cause” of the symptoms or disorder is central, because it determines financial responsibility. However, in the case of an allergic disorder and identified allergen, a claim requires more. Whose allergen? Where did it come from? These are crucial questions that must be answered. This paper explores the approaches to causal assessment which are important for the clinical allergist as he/she navigates the interface between clinical practice and legal proceedings. Its purpose is to help the allergist understand that interface, and to be prepared to enter an unfamiliar legal arena.
Highlights
Diagnosis, treatment, and prevention are the primary roles of the practicing physician
What is wrong with the patient? How do I treat him? How do I keep him well? Causal analyses are secondary, and, for most clinical fields, entirely unimportant
Did the contaminated drinking water cause the cancer? Did formaldehyde from the insulation cause the chronic rhinitis? Did the mold in the home arising from a leaking roof or window cause the child’s asthma? Did the asbestos in the workplace cause the lung cancer or was it the 40 pack-years of cigarette smoking? The answers to such questions are central to asserting liability claims against the polluter, the insulation installer, the home builder, or the asbestos producer in a court of law
Summary
Treatment, and prevention are the primary roles of the practicing physician. He may be asked to support that causal nexus with these types of questions: “Doctor, given the airborne level of mold spores found and the description of the water damage, was the duration and extent of potential exposure sufficient to have caused the patient’s asthma?” “What is your basis for that conclusion?” The purpose of this discussion is to elucidate, for allergists, this interface between clinical responsibilities of the doctor and legal demands of the patient as claimant and the court system. Has the allergist personally designed and performed any medical studies using the scientific method (control vs non-control groups) to confirm the validity of the opinion that the indoor apartment exposure to the specific molds in question under the extrapolated exposure and dose data are sufficient to a high degree of reliability in causing the specific medical illness and symptoms observed, after accounting for all confounding variables. The expert is not a combatant but rather a privileged participant [38]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
