AHPRA and IME’s

The WorkCover Victim’s Diary and Civil Forensic Psychiatry blogs have recently made commentary on issues with IME assessors and complaints processes.

I have previously blogged about issues with IME assessors.

IME’s – The Good, The Bad and the Ugly Pt 3

Dr Epstein has raised concern about undue impact on doctors from the AHPRA complaints investigation process while WorkCover Victim (I wish she would publicise her name) raises the issue of widespread bias and unprofessional conduct by IME assessors.

Dr Epstein states:

…….our concern is that a significant number of complaints about independent medical examinations are from disgruntled people who want to lash out at the IME if the opinion provided is not acceptable.

Doctors are frustrated by the trivial nature of many of the complaints, they are frustrated by the time and emotional energy expended in responding to these and by the economic cost.

APHRA – our enemy or our friend?

I have had concerns that the WorkCover Victim site doesn’t put forward solutions and tars all IME assessors with the same brush, but in the most recent post the following statement appears:

I am NOT saying all doctors in our workcover system are horrible creatures; many have indeed left the industry for private practice (rather, it is said that some have ‘retired into’ workcover examinations/assessments…), we believe better guidelines for IME (and the like) designations, along with rigid ethics requirements, stringent quality control and recordings of examinations/assessments of all injured workers must be seriously considered in order to save lives and indict criminals.

http://aworkcovervictimsdiary.com/2015/02/something-is-rotten-in-the-workcover-system/

While I think recording of examinations/assessments is impractical and would introduce a whole new set of problems, the other recommendations by WorkCover Victim are logical.

I have had my own recent experiences of doctors whose behaviour does not accord with my  understanding about what is professional, safe and reasonable. Concerns arise both with practitioners treating workers and IME assessors, but the latter issue is far more common.

I work in Tasmania and it is possible that the Tasmanian workers compensation and motor accident jurisdictions have more than their fair share of unprofessional or biased IME assessors (or assessors working outside their area of competence). In the absence of any enforceable professional standards for IME assessors and tightening of standards in interstate jurisdictions, it is likely that those assessors who cannot work elsewhere are flying in to Tasmania. Indeed the term ‘fly-in’ in the context of IME assessors has a negative connotation here amongst injured workers and treating practitioners.

Generally the worst IME offenders are only ‘weeded’ out of the system when the insurers realise that their opinions cause too many complaints and problems, or when they realise that their opinions do not ‘stand up in court‘. Unfortunately this realisation by the insurers can take a while (sometimes many years), to the detriment of fairness for the workers assessed while that process takes place. I understand (hearsay only) that one of the medico-legal provider organisations is bemoaning the problems they are having in recruiting quality practitioners to provide IME opinions. Perhaps the insurers too have the same concerns.

While Dr Epstein raises concerns about the frequency of  trivial complaints, the experience with patients I am treating is that they are perhaps too reluctant to complain. Patients who have suffered from what appear to be biased or unprofessional assessments are generally unwilling to raise any official complaint, be it with the local WorkCover authority or AHPRA. The Health Complaints Commissioner locally no longer accepts complaints about IME assessors, only complaints about practitioners involved in their treatment. I understand that a complaint about an opinion I expressed about a prospective worker’s unfitness to work in a particular role was the last formal complaint considered by that organisation!

My experience also is that doctors are also very unwilling to complain about other members of their profession, even when there are clear problems or they are doctors who fly in from another state. Doctor’s medical defence organisations advise extreme caution in raising complaints about ‘colleagues’ for fear of counter claims and other unintended consequences.

AHPRA does have an important role in dealing with complaints about doctors. I agree that process should be fair for the doctors and the complainants. Measures do need to be in place to screen out frivolous or trivial complaints, but in a jurisdiction like Tasmania where there are no standards for IME assessment issued by WorkCover and no auditing of IME reports, there should be no additional barriers in place for injured workers aggrieved by an IME assessor. There should also be a better mechanism for doctors to raise concerns about other doctors. Often it is the doctors who can most easily recognise the deficiencies in other doctors in terms of bias, unprofessional practice or lack of competence. While I recognise complaints from other doctors might be seen as an expression of professional jealousy or ‘turf wars’ there is still an important role for doctors . I don’t have all the answers about the best processes, but injured workers cannot be expected to know what is reasonable professionally, only recognise when they are treated rudely, roughly or accorded insufficient time to explain properly.

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About Tasworkdoc

As an occupational physician in private medical practice in Hobart, Tasmania - the southernmost state of Australia, I see workers referred by their general practitioners with various types of work-related injuries and diseases. These are mostly musculoskeletal injuries, both of traumatic and gradual onset as well as various associated psychological disorders. With interaction with patients for treatment and providing advice about rehabilitation, I have the opportunity, first-hand, to observe interactions between individual patients and compensation systems. I also conduct independent medical assessments, including impairment assessments for musculoskeletal injuries and asbestos-related disease compensation. This provides another perspective of workers within compensation systems.
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2 Responses to AHPRA and IME’s

  1. John Quintner says:

    Peter, the question you raise may be expressed as follows: how do we combat “the culpability of consciously cultivated ignorance” when it is clearly manifested in the reports of certain notorious “independent” medical examiners? I long ago came to the conclusion that our profession does not really care about this issue and that our society goes along with it because of the stigma attached to recipients of workers’ compensation payments and entitlements. I am sorry that I cannot be more constructive about how one might go about remedying the situation.

  2. Soula says:

    Thanks John! And thanks Peter for opening up this conversation.
    I have attended three IME’s. Injured workers are asked to attend these appointments knowing very well from the onset they are assessed against outdated guidelines and that they are guilty on arrival and have to prove their injuries. They have turned up having been left unpaid for, at least weeks, and the question directed is basically ‘are they really injured?’
    Very different attending if you felt you were being seen by someone who was there to help you. Anyone sitting on that panel is representing a workers compensation system and all hired by the Government and all abiding by strict guidelines, none are participating as the health care professionals they were sworn into.
    Eg. Within 5 mins during my last IME I was asked if my desk was a ‘sit or standing’ desk. I replied ‘it’s both, we made it so I can sit and stand’. i was told my answer was unacceptable and asked again if the desk was ‘sit or stand’. I repeated it was both and the practitioner raised his voice a little, stiffened his manner, put his pen down, took off his glasses and told me that he needed me to cooperate, that he needed to write a report that needed to be clear so I could be assessed properly, that I had to provide him with the information clearly so he could do his job and that if I was seeing him in his private practise we wouldn’t need to meet this criteria. Hello! I replied, ‘that is what I’m doing, telling the truth, providing accurate details, the desk is neither just one or the other, it’s both’. He actually changed his tone after that. We got on a little better although all three male practitioners proceeded to examing this female with neuropathic pain knowing very well, the guidelines didn’t allow them to do their job properly.
    I have so many awful experiences, including a neurosurgeon wishing me a miracle on the way out of the appointment (he also knew he couldn’t assess my neuropathic pain accurately from the onset). His piers should have certainly picked him up on that.
    You just need to turn the tables to find your answers here. Would anyone within the system stand and be assessed by the same system if they had a health issue? We know the answer is ‘no’ so why should injured workers have to and why are these HCPs working it? It’s upto the HCP to pull out here and demand a better system, the stigma against injured workers makes it impossible for us to be heard. And there is no way to complain, please! More trauma!

    And if it was all so bad for the system and injured workers are the monsters the system claims them to be then why not shut workers compensation down around Australia? But clearly it’s making bundles for our Government and the participating HCPs!

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