Readers of this blog might be interested to read the following article on my practice website about new Tasmanian requirements for IME assessment and giving expert evidence in court.
See link below:
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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.
Insult and Injury 
I think that blaming the Independent medical examinations for the system is not productive nor is it accurate. The vast majority of IME doctors are completely ethical – just because they may hold a different opinion does not make them unethical.
In my experience, the problem with most injuries is the lack of adequate treatment and by the time they get to an IME stage the patient has developed a chronic pain / depression cycle.
With all due respect to GPs who are inadequately remunerated and thus must churn through patients, most injured people seem to given pain killers, and told to go away for a few weeks, then they return for the usual CT scan (unnecessary radiation) and X-rays which show either nothing or degenerative changes, then they are told there is nothing on the x-rays and they keep going with the Tramadol for another 6 months and then they return and get some passive physiotherapy and then turn up to an IME with, not unsurprisingly, deconditioning, weight gain, muscle weakness, chronic pain and depression and a couple of unsuccessful attempts at return to work under their belt.
How this is characterised in a medicolegal sense using evidence based medicine and legal evidence then becomes problematic which leads to duelling opinions and frustrated and angry patients / claimants.
Instead of blaming IME doctors, perhaps it would be better to concentrating on how the system can ensure early and effective activity based treatment and ideally introduce a no fault compensation system and increase the use of medical panels and doctors appointed by the Workcover authorities.
Thanks Tania
IME’s can have different opinions to the treaters and to hold a different opinion is certainly not unethical. I am not sure which jurisdiction you are familiar with, but I believe there is a problem with bias by at least a few IME assessors who operate in Tasmania. There are many who fly in from other jurisdictions. I am aware from discussions with insurers that they too have concerns about some practitioners and, at times, they stop using certain practitioners for IME assessments because of these concerns.
In my own specialist occupational practice when I am treating injured workers it is not uncommon to see the whole downward spiral of chronic pain and depression start after an IME assessment, with a change of focus by the worker from rehabilitation and recovery to proving their case, to the detriment of recovery.
I also agree that you can’t blame IME assessors for all poor outcomes and the factors you identified are important, particularly lack of time for doctors to manage a case, which is an issue in current models of general practice. You might be interested in my forthcoming article about complex case management by doctors, about to be published (hopefully later tonight).
The article is called:
‘Towards Simplicity – Complex Case Management by Doctors’
I do thoroughly endorse your last comment:
‘….it would be better to concentrating on how the system can ensure early and effective activity based treatment and ideally introduce a no fault compensation system and increase the use of medical panels and doctors appointed by the Workcover authorities.’
Peter Sharman