FW: IME's and other Scourges of Society - My response to Mike

[Guest guest]

Dr. Albright,

As my private email said ' Thanks for coming forth.' From your long

treatise I now see how my own IME generated a 28 page report !

Given the fact that those who speak or write are at known risk for

criticism, I am wondering not 'who', ( you could mean me), but 'what'

you see are the 'enemies of Chiropractic' ?

sharron fuchs dc

IME's and other Scourges of Society - My response

to Mike

I apologize in advance to everyone for the length of this post- but

hope you take the time to read through it.

I am both an IME examiner (identified by Mike- for apparently completely

unreasonable opinions and other transgressions, I am sure)- as well as a

private practice DC.

First of all I have always respected Mike and the Gatti Firm.

However, I find his comments particularly about me to be inaccurate and

inflammatory.

Certainly, as I think everyone would agree, examinations of any sort are

a " snapshot " of an individual at a specific point in time. No one can

ever say with absolute certainty how that person was the day before or

how they

will be the day after. Everyone - attornies, adjusters and certainly

the

patients love to ask questions about the future and do. Like it or

not,

that is part of all of our jobs to attempt to answer wonderful questions

like that ... Attornies want to know how this injury will affect a

person

in the future for work and quality of life and everything else so they

can figure that into the settlement. Adjusters want to know when they

can " cut "

someone off and patients want to know when they will stop hurting.

One thing that is interesting to me being part of the IME system is that

I get to see what " everyone " does with their patients - both in the

sense of management as well as concerning documentation. One thing that

concerns me is that despite all the " banter " on this exchange as well as

during conventions (both CAO and ODOC) about documentation - I see

FREQUENT egregious examples of poor documentation and endless, frequent

treatment without direction. This is not to say that my practice

documentation is excellent or should be held as an example or anything

else - but when I see

12 months or objective findings that are barely legible and consist

solely

of " R T12, L S/I, PA R radius " - and there is no re-exam or

consultation

or MRI or anything else, that is ridiculous. That is then compounded

by

the fact that when I interview the patient for the IME, they tell me

they are having daily 7/10 VAS pain on a constant daily basis and feel

only 20% better overall since their injury - despite 12 months of

chiropractic care for a 5mph rear impact.

I am sure F. will now chime in regarding low speed impacts and

just to pre-empt that firestorm - The fact I included a 5 mph impact in

the above case really has nothing to do with whether injury took place

or not - I am sure has statistics somewhere that can show you

can get anything

from TB to tooth decay from a 5 mph'r - It does EMPHASIZE that cases

such

as those, however, require a higher level of documentation regarding

injury

and care - in my opinion of course. I certainly see low speed crash

injuries in my practice and I have the same insurance adjusters as

everyone else attempting to cut me off. My patients certainly get sent

to IME's and I have to deal with them the same way as all of you. From

what I can tell, there really is no rhyme or reason to who gets sent for

these or when. I get my bills reduced or held and go through the same

red tape as all of you - there are certainly no adjuster " perks " for me

because I do IME's.

On the other side of documentation, I find just as offensive - 10 page

type written intake reports that document every examination procedure

that one can find in a text book, performed just because it is on that

examiner's form. Or also " computer generated charts " that say precisely

the same thing

with a couple of sentences switched around month after month. Show

some

purpose and be reasonable - I don't think anyone can reasonably expect

more than that.

Back to the specific topics raised by Mike - Mike, I have talked to

you

and met you and you are certainly a smart guy and quality attorney - you

should know better than taking a specific quote or answer to a specific

question and trying to use that to convey a general " tone " or use it to

establish a pattern of behaviour. Mike's quote of me unfortunately

does

not ring any bells regarding that specific person or examination - but

in general I would characterize my reports (given the amazing things I

see) to

be generous in the scheme of IME's and chiropractic care. I

specifically

DO NOT RETROACTIVELY deny care in any circumstance. In Mike's example,

I

opined the person was stationary as of the date of my examination.

Mike's characterization that his client " continued to get better " after

that point

is misleading. I have no doubt that seeing my patients 3 times per

week-

forever -would make them feel better, help with all aspects of function

and

overall well being - but that is not what the issue is. In regards to

any

IME comment regarding excessiveness or unreasonableness, I seldom if

ever apply these terms retroactively and can only think of one case

(file review) I did out of Washington where an individual didn't report

for initial treatment of a low speed impact for nearly 3 months. Then

treated for over

12 months at an average frequency of 4 visits per week for that time

with relatively no change to VAS scores, disability index scores or any

other seemingly objective finding all without x-ray, consultation, MRI

or physical therapy.

I am particularly offended by Mike's comment suggesting that the fact

his examples were Hispanic patients - that somehow IME's discriminated

against these patients for this fact. SINCE my name was specifically

included in his " hit list " whether or not his comment was directed at me

- the implication to everyone is that I am somehow discriminatory and

racist- I am personally hurt by his association.

Since I am not a Spanish speaker, all of my examinations of this nature

are conducted with an extremely qualified translator. In fact, most are

conducted with one individual who is credentialed as college instructor.

These examinations take MUCH longer and I go great lengths to make sure

information is accurately relayed in both directions. Additionally, I

rely on the translator to help me with any of my post exam questions

regarding demeanor, cooperation, evasiveness etc. that I may have lost

via

translation. HOWEVER, when I have individuals of any race, color or

creed

act evasive, uncooperative, tell me everything hurts including merely

brushing my hand across their back and their injury occurred 6-12 months

ago, something is not right.

I certainly did not go to chiropractic school with the life dream of

doing

IME's. I certainly do not do these as my " primary " chiropractic

activity.

I certainly cannot speak to any results via MD conducted IME's, though I

would characterize them as being less generous towards chiropractic care

and certainly more willing to offer " retroactive " denial of rendered

services

(both medical and chiropractic). I do occasionally do " panel "

examinations

with other providers. I am much less fond of these examinations as I

find

these specialist seem to be more " insurance advocates " - though that

again is my personal opinion.

I haven't actively participated in this forum in the past, though I am

one

of those " lurkers " it was suggested should come out and identify

oneself.

Quite honestly I have gone through phases were I have just " blocked "

incoming because the exchanges seemed ridiculous to me. But one of the

clear re-current themes is that MANY are always ready to jump onboard

and point a giant finger at this culprit or that culprit - because THEY

are the

root of all evils. If I can run down the litany, based on

recollection, I

think these have included in the past - Attornies, MD's, Insurance

companies, Milk, ODOC, CAO, OBCE, Clinical justification rule, Colossus,

W., Kerry, Freeman - now me. I am either in good

company or bad. Oh well.

I am tired of the finger pointing, I am tired of the threats - and yes

Mike, the fact you suggest " these are the very cases that perhaps the

OBCE should

look into " is indeed a threat albeit in an indirect manner. I am proud

of

the way I conduct the IME's I perform. I work with the information I

have been provided (which is admittedly not always complete) and do my

best to objectively give my opinion and answer the questions posed. I

do review every single document provided to me. And while everyone

argues over terminology - " independent medical exam " vs. " insurance

medical exam " or whatever - The one thing I can say without hesitation

is that I have never been pressured to provide an opinion either way, I

have never " consulted the adjuster " before an exam " to see what they

wanted me to say " , I have often gone into an exam after reading the

records with a pre-conceived notion as to what I thought, only to come

out thinking completely the opposite. I say without hesitation that my

exams are indeed " independent. " They are indeed

" objective " and they are indeed my " opinion " - for better or worse.

I do

not " court " the insurance companies. If they don't like what I say and

in many cases they don't, they will just stop allowing me to do exam's

via the IME company.

I specifically challenge Mike or even Freeman to say any of

those

things about " AME's " (my own term I think). That would be Attorney

Medical Exam's - wherein " preferred providers " via attornies are sought

for their " expertise " - and often most if not all of these individuals

perform these services as their primary vocation. They are often

consulted before the exam or before the report is generated with " their

findings " and even suggested to NOT generate a report if the findings an

unsupportive.

Additionally, fees for services related to these exams are often no less

than " amazing " . I think it would be easy to see how this type of

behaviour could be construed as to " perpetuate disability " or to

document myriads of

" unrecognized pathology " . Of note - and again in my opinion - you

don't

ever see exams such as these done a month or two or even six into

treatment where perhaps a patient says " Hey attorney or doctor - I am

not getting

better. What is wrong or what should I do? " These generally done a

year

later or more seemingly when the settlement is not going as well as

hope.

Perhaps the Bar Association, OBCE or who the heck ever should look into

that

practice. BUT before I start a torrent of responses....

I included the last paragraph not to incite a riot, threaten, imply any

impropriety on anyone's part, or even to REALLY suggest that and

investigation of any sort needs to be done. I did it because I am sick

of everyone pointing fingers (glass house's people) and in particular

people alleging to SUPPORT chiropractic (in the biggest way) and yet

when it comes down to it (having lurked on these exchanges long enough)

- it would seem that many of the frequent contributors and alleged

advocates are our worst enemies.

I stand by my IME opinions- whether people like them or not. If, based

on my opinion, your patient, client, mother or sister got cut off - I

apologize. In all cases, I try to give the patients (and treating

chiropractors) the benefit of the doubt - often more than I think many

of you deserve via documentation I see.

My short message, for those of you who saw this iceberg of an posting

and skipped to the bottom, is everyone just needs to be reasonable and

" take care of business " . Take care of your patient's in the manner they

deserve - which means documenting their injuries and at least giving the

implication you are doing something other than collecting their money

and life is good.

Mike and the Gatti folk are all great people and I know his

posting

was meant in the spirit of his client's best interest. Obviously when

your patient gets a bad IME or whatever, they would be happy take care

of them.

Thanks for playing and have a nice day. Now let's get back to that

milk

discussion.

Greg Albright DC

Keizer, OR

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