Independent Medical Exams (IME’s)
Independent Medical Exams are often requested to help in matters of dispute. The referral source needs to be identified by the examiner and the reason for the exam should be discussed with the patient as well. IME’s differ from your routine patient encounter in that the physician is not entering into a treatment relationship with the patient. To maintain an unbiased attitude no patient-physician relationship is established. The physician is usually provided records to review, obtains a history from the patient and performs a pertinent physical exam. She/he then answers the medical questions raised by the referral source by generating a report which details their findings.
Most often the IME physician is requested to address issues of causation. To do so an accurate diagnosis needs to be made. Questions regarding previous and future treatment needs are also often answered. Whether or not the patient has reached a point of Maximum Medical Improvement (MMI) can be another issue. If no further medical treatment will improve the patient’s condition, than they likely are at MMI. If so a Permanent Partial Impairment (PPI) may be requested. PPI’s involve a calculation that is driven by the diagnosis and severity of the condition. Most physicians use “The AMA Guide to Determine Permanent Partial Impairment” as a resource to maintain consistency and fairness when determining impairment. The patient’s capacity to function can also be addressed as disability issues may impact their future earning potential.
I have done IME’s for over 20 years. I an ideal situation the physician would be blinded to the source of the referral. However that is not possible so it is the responsibility of the IME physician to maintain impartiality and address all the issues honestly. As a physician we still have a responsibility to treat the patient with dignity and fairly. If we find a diagnosis that has been undertreated or missed it is our responsibility to identify it. Likewise if the patient has received adequate treatment and no further efforts are likely to improve their condition than this needs to be stated.
Our opinions will be based on our experience and training and can as well be supplemented by scientific evidence such as recent articles or medical textbooks when necessary. The physician may use terms such as medically “probable” or “more likely than not” when opining on diagnosis or causation. The medical-legal standard is always some variant of what is probable or likely, something that if converted to percentages would indicate something greater than 50%.