This is a quote from an
article written by a so-called 'Independent' Medical Examiner:
". .
. However the most common communication between attending/treating physician
and Independent Medical Examiner is not direct (sic) one but rather an indirect
one via the medical record generated by the attending physician, which can be
valuable in assessing an individuals claim of impairment or disability.
It would be an Independent Medical Examiners dream come true if the
information in the attending physicians record were completely accurate,
consistent and reliable. Unfortunately, this is often not the
case.
No one will argue that in North America we are fortunate to
have the finest medical care provided by most systematically trained and
dedicated health care providers the world has ever known. Unfortunately for the
society at large, there is a tremendous pressure placed on these fine folks
to exaggerate services performed to insure that the patients receive
benefits and to some degree optimize reimbursement for the provider.
We are all aware of anecdotal evidence that suggests that the more
diagnoses that are listed, the more likely the chance of payment being made and
some providers may have taken this to creative heights. Obviously, where
the payor is a liability company such as automobile insurance carrier or
workers compensation carrier, there is temptation to maximize
disability. This has led some to conclude that there is an environment,
which does nothing to correct the pressure to exaggerate medical illness and a
system where much money is available for those who are intentionally
exaggerating the need for medical services or indicating the performance of a
service in a workers compensation claim which was not work-related, a
phenomenon I regard as cost shifting.
In this regard, Independent
Medical Examinations tends to offer a more neutral type of opinion;
however, this system is also not without its abusers. We all know of some
physicians who do nothing but plaintiff work and others that exclusively
perform examination for defense. This ends up in some cases a shouting match
between two equally qualified physicians described by some as dueling doctors
phenomenon.
So then, what are we supposed to do? I believe that the
quality and integrity of the medical records coupled with the intellectually
honest and objective analysis of all the information made available to the
independent medical examiner is the appropriate course of action. It is
imperative to evaluate the source of attending physicians information and
weigh the veracity of these records by many factors. These should include
sifting through data from variety of sources and appropriate second opinion
consultation from colleagues with appropriate specialty. Hopefully the American
Board of Independent Medical Examiners and the Journal Disability Medicine will
continue to contribute to this interdisciplinary approach."
Mohammed I.
Ranavaya, M.D., M.S., FRCPI, FFOM, FAADEP, CIME Editor in Chief
Disability Medicine is an educational publication of the American Board of
Independent Medical Examiners (ABIME) http://www.abime.org/
Full article at: http://www.abime.org/documents/journalv3n2.pdf
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Most injured
workers who have contacted the CIWS have stated that the attending physician or
specialist's diagnosis of their injury is more accurate than the analysis done
by the doctor who is being paid by the workers compensation board (the 'IME' or
WCB-paid doctor). Therefore, most injured workers would disagree with the above
criticism of the attending physician.
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