If your patient has been injured in an auto accident, there’s a good chance he/she will be required to submit to an “independent medical examination” (IME). As your patient’s treating physician, you are in a position to help minimize the trauma of this inherently threatening experience.
You are probably well aware that many people are apprehensive of being examined even by physicians whose job is to care for them. You can imagine the anxiety which must accompany your patient’s surrendering his/her personal, physical and medical privacy to the scrutiny of one or two medical professionals whose job is to examine him/her with cold detachment, if not skepticism.
In our part of the world, doctors performing IME’s range from those who display scrupulous intellectual honesty, to those who go out of their way to find in favor of the insurance company’s position if at all possible, to those rare individuals who so lack independence as to be singled out in published legal opinions as bordering on being intellectually dishonest. Whatever the content of the opinion eventually rendered, it’s no secret that insurance companies do not hire their IME doctors for their bedside manner. How can you help your patient through this experience?
We believe part of our job as counsel for someone with a personal injury claim is to prepare them for this experience. Your awareness of these basic guidelines will enable you to reinforce such counsel, or fill the gap for patients who may not have received such counsel.
The examining doctor will probably he a specialist for the type of injury the person has suffered and will probably have performed many such exams for defense attorneys and insurance companies. Your patient or his/her attorney is entitled to a copy of the examiner’s report and should ask for one as soon as it becomes available.
The patient should he prompt, courteous and friendly and should try not to show any resentment, with the process or impatience if made to wait. Maintaining one’s “cool” is important, since negative reactions may be recorded and/or reflected adversely in the examining doctor’s report. At the same time, abuse should not be tolerated.
In California, patients have an absolute right to bring a witness (a spouse or friend of the same gender) into the examining room. Oregon examinees are advised to bring someone along who will, in most cases, be allowed in.
The attitude, professionalism and manner of IME doctors run the gamut. Patients should be reminded that these doctors have no economic or professional incentive to be nice to them.
Patients should not be tempted to go into detail about how the accident happened. The doctor’s job is to perform a physical exam to verify or refute claimed injuries/medical problems, not to get into how the accident occurred. Nonetheless, the doctor may ask many such questions. Patients should say as little as possible and be as general as possible since whatever they say may be noted and interpreted against them later. In fact, answers to all questions should be kept to a simple minimum. Patients should not get “chatty,” as their extra comments will probably be misconstrued in a way that is ultimately harmful. Patents should be prepared to answer questions about their past medical history, especially other injuries before and since the accident.
Patients should be sure to tell the examiner all their present symptoms, everything they are feeling. They should tell about all the accident injuries and resulting symptoms, but if something no longer hurts, they should tell the doctor that too.
Most importantly, patients should present their symptoms accurately, without exaggeration. They should not, for example, limp to impress the doctor with how much pain they are feeling, unless they cannot walk without a limp. On the other hand, since the effects of restricted activity and regular treatment may temporarily diminish the pain which genuinely indicates persisting injuries, patients might be advised to limit treatment and attempt normal activities in the days prior to the exam, if it would help to give the examining doctor a more accurate picture of their true physical condition.
Patients should not submit to new x-rays or other such medical tests (beyond temperature and blood pressure) without checking with their attorney.
Noting the exact times they arrived, when they were called to the examining room, when the exam began and was completed, etc., may prove useful later in rebutting claims of a “lengthy and thorough” exam. Also, as soon as possible after the exam, patients should jot down all they can remember of what the doctor asked, what they answered, what the doctor did, how long they waited, how they felt, etc. The patient should give this report to his/her attorney to be read alongside the IME report.
Basically, patients should know the examining doctor is not there to treat them or to be helpful or friendly; and that the patient’s job is to be honest and cooperative.
Finally, it would be helpful to your patient if you told him/her that you would like to see a copy of the IME report. Your interest would not only be encouraging, but also, if your views differ from the examining doctor, may be useful as rebuttal evidence, especially if you have seen the patient around the time of the IME. In your role as treating doctor, you can be of invaluable emotional and evidentiary assistance.
This article was prepared by Dennis H. Black