EPISODE · Apr 7, 2026 · 33 MIN
E04: Multi-Cause Cases with Dr Pamela Boekel
from Medico-Legal Mastery
Most medico-legal cases don't arrive clean. They arrive with decades of GP notes, pre-existing pathology, and a new incident sitting on top of all of it. The job isn't just assessing what happened. It's working out what was already there, what changed, and what the evidence can actually support.Dr Pamela Boekel is a Melbourne-based orthopedic surgeon specialising in shoulder and elbow surgery, with appointments across the Northern Hospital and Health Network, St Vincent's East Melbourne, and John Faulkner Hospital. She conducts IME assessments every week alongside an active public and private clinical practice.Host Jess Marshall asks the questions every IME practitioner faces in complex, multi-cause scenarios:When a claimant has decades of pre-existing pathology and a new incident layered on top, where do you even begin?What does the AMA Guides framework actually allow you to apportion when prior documentation is incomplete or missing entirely?Why do compensable cases consistently trend worse than equivalent non-compensable presentations, and what does that mean for natural history opinions?How do you assess delayed presentation without defaulting to skepticism?When objective findings and subjective complaints diverge across multiple claims, how do you separate what belongs to what?Dr Boekel's approach starts with the patient, not the file. She establishes baseline before she opens the records, and she applies the Guides with precision when the documentation supports it and honesty when it doesn't. On the gap between what a patient experiences and what a report can capture:"It doesn't give a full picture. And certainly I do feel for these patients when they have these separated claims which we can't combine."Dr Boekel covers multi-cause assessment frameworks, incomplete records and apportionment, CRPS and the Budapest criteria, delayed presentation in physical workers, and what it means to be one of fewer than 100 female orthopedic surgeons in Australia.Medico-Legal Mastery is proudly supported by Melbourne Medicolegal. Hosted on Acast. See acast.com/privacy for more information.
What this episode covers
Most medico-legal cases don't arrive clean. They arrive with decades of GP notes, pre-existing pathology, and a new incident sitting on top of all of it. The job isn't just assessing what happened. It's working out what was already there, what changed, and what the evidence can actually support.Dr Pamela Boekel is a Melbourne-based orthopedic surgeon specialising in shoulder and elbow surgery, with appointments across the Northern Hospital and Health Network, St Vincent's East Melbourne, and John Faulkner Hospital. She conducts IME assessments every week alongside an active public and private clinical practice.Host Jess Marshall asks the questions every IME practitioner faces in complex, multi-cause scenarios:When a claimant has decades of pre-existing pathology and a new incident layered on top, where do you even begin?What does the AMA Guides framework actually allow you to apportion when prior documentation is incomplete or missing entirely?Why do compensable cases consistently trend worse than equivalent non-compensable presentations, and what does that mean for natural history opinions?How do you assess delayed presentation without defaulting to skepticism?When objective findings and subjective complaints diverge across multiple claims, how do you separate what belongs to what?Dr Boekel's approach starts with the patient, not the file. She establishes baseline before she opens the records, and she applies the Guides with precision when the documentation supports it and honesty when it doesn't. On the gap between what a patient experiences and what a report can capture:"It doesn't give a full picture. And certainly I do feel for these patients when they have these separated claims which we can't combine."Dr Boekel covers multi-cause assessment frameworks, incomplete records and apportionment, CRPS and the Budapest criteria, delayed presentation in physical workers, and what it means to be one of fewer than 100 female orthopedic surgeons in Australia.Medico-Legal Mastery is proudly supported by Melbourne Medicolegal. Hosted on Acast. See acast.com/privacy for more information.
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E04: Multi-Cause Cases with Dr Pamela Boekel
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