Re: requesting IME-legal please chime in

[Guest guest]

I recently voiced my concerns about a similar patient so called his adjuster and requested an IME. I was laughed at. I was very careful with what I said about the patient, but basically that the subjective info did not correlate with the objective findings and that I did not feel further care was necessary. Luckily, I had plenty of documentaion to support this. Turns out he found another DC who was happy to continue months and months of additional treatment. But, I washed my hands of him.Am curious as to how others handle these situations. Best of luck, BarrettSent from my Verizon Wireless BlackBerrySender: oregondcs Date: Wed, 20 Jun 2012 00:04:37 -0000To: <oregondcs >Subject: requesting IME-legal please chime in dear listserve,I just got a new MVA pt who has been seen from 2 other practioners. Pt's symptoms do not correlate with physical exam findings and there is generally an appearance of malingering- pt dislikes her job, there is marital dichord and the pt is deconditioned- Pt's accident was almost 4 months ago, " bump " in the parking lot kind of thing-with resulting severe neuro deficits, exaggarated muscle weakness,etc.... Xrays were ordered from another practioner, all were negative.Question-can I quietly hint or request an IME? this is a new one for me- personally, I do not want to treat for more than a couple of visitsLegally, what are my responsibilities regarding putting an end to this and what might the repercussions be?Thanks Babbbitt, Forest Grove Health and Fitness

[Guest guest]

Hmmm, I remember being trained in “Malingering” orthopedic testing.

ph Medlin D.C.

From: Franchesca Vermillion

Sent: Wednesday, June 20, 2012 12:04 PM

To: 'Oregon DC's'

Subject: requesting IME-legal please chime in

It is important to not state the patient is malingering. That diagnosis requires a psychological component which is not in our scope to make. If the patient states flat out, " I am making this up to recieve more care or obtain disability" then you can chart that and show them to the door. It is better to state symptoms to not match findings or that the patient seems to be a symptom magnifier. There is also nothing wrong with tell the patient you cannot find anything which points to their symptoms. You can let them know you need a second opion or that you do not think you are the doctor to help them out. We will have to have difficult coversations from time to time. It is important not to cater to the patient but do what is best for them, even if that means they do not need care at this time. Respectfully, Franchesca Vermillion, DCVermillion & Bloom, PCBalance & Fitness throughChiropractic Rehabilitation1750 Blankenship Rd Ste 295West Linn, OR 97068www.vermillionbloom.com

To: portlandchiro1@...; danm@...CC: kellybpdx@...; dr.babbitt@...; oregondcs From: drbob@...Date: Tue, 19 Jun 2012 21:27:30 -0700Subject: RE: ****SPAM**** Re: requesting IME-legal please chime in

USE OF THE VARIOUS MALINGERING TESTS AS WELL AS PRESSURE SENSITIVE QUANTIATIVE TESTING OF THE AREAS OF COMPLAINT. (REPEAT TWICE AND COMPARE THE NUMBERS)

bOB

W. Pfeiffer, D.C., D.A.B.C.O.

Lee Pfeiffer, R.N., B.S.

46 N.E. Mt. Hebron Dr. (no USPS mail)

P.O. Box 606

Pendleton, OR 97801

drbob@...

leernbs@...

All people smile in the same language

From: oregondcs [mailto:oregondcs ] On Behalf Of SchneiderSent: Tuesday, June 19, 2012 8:55 PMTo: Cc: kellybpdx@...; dr.babbitt; oregondcs Subject: Re: ****SPAM**** Re: requesting IME-legal please chime in

I too had a suspicious patient who I had doubts about recently. I referred patient to Dr. Saboe and the situation was handled quite professionally . I would agree with Dr. 's sound advice-and send this suspicious patient to a trustworthy DC who can do an IME. I would highly recommend Dr. Saboe. Schneider DCPDX

We as a profession must be honest with our assessments. If we, as an individual practitioner, feel the patient does not need care, is malingering or otherwise, we must report our findings in our notes. Do not treat this patient under the auto insurance if your findings do not support such care. There may always be chiropractors that turn the other cheek in order to make a buck, and unfortunately those are the ones that give the rest of the profession a bad name. If you choose not to see them based upon your evaluation, send that information with your exam bill to the insurance adjuster. They will likely use that information later to close the case, if it is well documented.Requesting an IME does not need to go through the insurance company though. You may request a second opinion from another chiropractor asking them specifically if there are injuries from this crash that need ongoing treatment. Hopeful ly you choose someone honest and ethical and they will give an appropriate response.But most importantly, do not treat someone you do not feel needs it.dan miller dc> I recently voiced my concerns about a similar patient so called his adjuster and requested an IME. I was laughed at. I was very careful with what I said about the patient, but basically that the subjective info did not correlate with the objective findings and that I did not feel further care was necessary. Luckily, I had plenty of documentaion to support this. Turns out he found another DC who was happy to continue months and months of additional treatment. But, I washed my hands of him.>> Am curious as to how others handle these situations.>> Best of luck,> Barrett>> Sent from my Verizon Wireless BlackBerry> > Sender: oregondcs > Date: Wed, 20 Jun 2012 00:04:37 -0000> To: <oregondcs >> Subject: requesting IME-legal please chime in>>> dear listserve,>> I just got a new MVA pt who has been seen from 2 other practioners. Pt's symptoms do not correlate with physical exam findings and there is generally an appearance of malingering- pt dislikes her job, there is marital dichord and the pt is deconditioned- Pt's accident was almost 4 months ago, "bump" in the parking lot kind of thing-with resulting severe neuro deficits, exaggarated muscle weakness,etc.... Xrays were ordered from another practioner, all were negative.>> Question-can I quietly hint or request an IME? this is a new one for me- personally, I do not want to treat for more than a couple of visits>> Legally, what are my responsibilities regarding putting an end to this and what might the repercussions be?>> Thanks>> Babbbitt, Forest Grove Health and Fitness>>>------------------------------------All posts must adhere to OregonDCs rules located on homepage at: http://groups.yahoo.com/group/oregondcs/Tell a colleague about OregonDCs! (must be licensed Oregon DC)

[Guest guest]

I used to do a battery of these tests with PIP and WC cases. Now with FAKTR techniques I treat many of this patients that I used to think were crazy with good results. Clearly there are those patients that are using the system or need mental healthcare.Sent from I-phoneTed Forcum, DC, DACBSP Hmmm, I remember being trained in “Malingering†orthopedic testing. ph Medlin D.C. From: Franchesca Vermillion Sent: Wednesday, June 20, 2012 12:04 PMTo: 'Oregon DC's' Subject: requesting IME-legal please chime in It is important to not state the patient is malingering. That diagnosis requires a psychological component which is not in our scope to make. If the patient states flat out, " I am making this up to recieve more care or obtain disability" then you can chart that and show them to the door. It is better to state symptoms to not match findings or that the patient seems to be a symptom magnifier. There is also nothing wrong with tell the patient you cannot find anything which points to their symptoms. You can let them know you need a second opion or that you do not think you are the doctor to help them out. We will have to have difficult coversations from time to time. It is important not to cater to the patient but do what is best for them, even if that means they do not need care at this time. Respectfully, Franchesca Vermillion, DCVermillion & Bloom, PCBalance & Fitness throughChiropractic Rehabilitation1750 Blankenship Rd Ste 295West Linn, OR 97068www.vermillionbloom.com To: portlandchiro1@...; danm@...CC: kellybpdx@...; dr.babbitt@...; oregondcs From: drbob@...Date: Tue, 19 Jun 2012 21:27:30 -0700Subject: RE: ****SPAM**** Re: requesting IME-legal please chime in USE OF THE VARIOUS MALINGERING TESTS AS WELL AS PRESSURE SENSITIVE QUANTIATIVE TESTING OF THE AREAS OF COMPLAINT. (REPEAT TWICE AND COMPARE THE NUMBERS) bOB W. Pfeiffer, D.C., D.A.B.C.O.Lee Pfeiffer, R.N., B.S.46 N.E. Mt. Hebron Dr. (no USPS mail)P.O. Box 606 Pendleton, OR 97801drbob@...leernbs@... All people smile in the same language From: oregondcs [mailto:oregondcs ] On Behalf Of SchneiderSent: Tuesday, June 19, 2012 8:55 PMTo: Cc: kellybpdx@...; dr.babbitt; oregondcs Subject: Re: ****SPAM**** Re: requesting IME-legal please chime in I too had a suspicious patient who I had doubts about recently. I referred patient to Dr. Saboe and the situation was handled quite professionally . I would agree with Dr. 's sound advice-and send this suspicious patient to a trustworthy DC who can do an IME. I would highly recommend Dr. Saboe. Schneider DCPDXWe as a profession must be honest with our assessments. If we, as an individual practitioner, feel the patient does not need care, is malingering or otherwise, we must report our findings in our notes. Do not treat this patient under the auto insurance if your findings do not support such care. There may always be chiropractors that turn the other cheek in order to make a buck, and unfortunately those are the ones that give the rest of the profession a bad name. If you choose not to see them based upon your evaluation, send that information with your exam bill to the insurance adjuster. They will likely use that information later to close the case, if it is well documented.Requesting an IME does not need to go through the insurance company though. You may request a second opinion from another chiropractor asking them specifically if there are injuries from this crash that need ongoing treatment. Hopeful ly you choose someone honest and ethical and they will give an appropriate response.But most importantly, do not treat someone you do not feel needs it.dan miller dc> I recently voiced my concerns about a similar patient so called his adjuster and requested an IME. I was laughed at. I was very careful with what I said about the patient, but basically that the subjective info did not correlate with the objective findings and that I did not feel further care was necessary. Luckily, I had plenty of documentaion to support this. Turns out he found another DC who was happy to continue months and months of additional treatment. But, I washed my hands of him.>> Am curious as to how others handle these situations.>> Best of luck,> Barrett>> Sent from my Verizon Wireless BlackBerry> > Sender: oregondcs > Date: Wed, 20 Jun 2012 00:04:37 -0000> To: <oregondcs >> Subject: requesting IME-legal please chime in>>> dear listserve,>> I just got a new MVA pt who has been seen from 2 other practioners. Pt's symptoms do not correlate with physical exam findings and there is generally an appearance of malingering- pt dislikes her job, there is marital dichord and the pt is deconditioned- Pt's accident was almost 4 months ago, "bump" in the parking lot kind of thing-with resulting severe neuro deficits, exaggarated muscle weakness,etc.... Xrays were ordered from another practioner, all were negative.>> Question-can I quietly hint or request an IME? this is a new one for me- personally, I do not want to treat for more than a couple of visits>> Legally, what are my responsibilities regarding putting an end to this and what might the repercussions be?>> Thanks>> Babbbitt, Forest Grove Health and Fitness>>>------------------------------------All posts must adhere to OregonDCs rules located on homepage at: http://groups.yahoo.com/group/oregondcs/Tell a colleague about OregonDCs! (must be licensed Oregon DC)

[Guest guest]

Personally, I think the best route is to just document Subjective

and Objective complaints, make your professional comment that you

don't see the need for any further care since the two don't match

up, and then release the patient from care.  Once the adjuster sees

the notation, and the fact that the patient has now moved on to

another provider, they will order an IME if they are worth two

cents. 

This will put you in the position of being the one who cut off care

and the adjuster will remember in the long run who helped them out. 

It may not come back right away, but some time, some day, you will

be dealing with that adjuster again and your bills will have very

little review and sail through to payment.

Grice, DC

Albany, OR

On 6/20/2012 12:04 PM, Franchesca

Vermillion wrote:

 

It is important to not state the

patient is malingering. That diagnosis requires a

psychological component which is not in our scope to

make. If the patient states flat out, " I am making this

up to recieve more care or obtain disability" then you

can chart that and show them to the door.

 

It is better to state symptoms to not

match findings or that the patient seems to be a symptom

magnifier. There is also nothing wrong with tell the

patient you cannot find anything which points to their

symptoms. You can let them know you need a second opion

or that you do not think you are the doctor to help them

out. We will have to have difficult coversations from

time to time. It is important not to cater to the

patient but do what is best for them, even if that means

they do not need care at this time.

Respectfully,

 

Franchesca

Vermillion, DC

Vermillion

& Bloom, PC

Balance  & Fitness

through

Chiropractic Rehabilitation

1750 Blankenship Rd

Ste 295

West Linn,

OR 97068

www.vermillionbloom.com 

 

 

 

To: portlandchiro1@...;

danm@...

CC: kellybpdx@...; dr.babbitt@...;

oregondcs

From: drbob@...

Date: Tue, 19 Jun 2012 21:27:30 -0700

Subject: RE: ****SPAM**** Re:

requesting IME-legal please chime in

 

USE OF THE VARIOUS

MALINGERING TESTS AS WELL AS PRESSURE

SENSITIVE QUANTIATIVE TESTING OF THE AREAS

OF COMPLAINT. (REPEAT TWICE AND COMPARE THE

NUMBERS)

 

bOB

 

W.

Pfeiffer, D.C., D.A.B.C.O.

Lee Pfeiffer,

R.N., B.S.

46 N.E. Mt.

Hebron Dr. (no USPS mail)

P.O. Box 606

Pendleton, OR

97801

drbob@...

leernbs@...

 

All people smile

in the same language

 

From:

oregondcs

[mailto:oregondcs ] On

Behalf Of Schneider

Sent: Tuesday, June 19, 2012 8:55

PM

To:

Cc: kellybpdx@...;

dr.babbitt; oregondcs

Subject: Re: ****SPAM**** Re:

requesting IME-legal

please chime in

 

 

I too had a suspicious patient who I had

doubts about recently.  I referred patient

to Dr. Saboe and  the situation was

handled quite professionally .  I would

agree with Dr. 's sound advice-and

send this suspicious patient to a

trustworthy DC who can do an IME.  I would

highly recommend Dr. Saboe.

Schneider DC

PDX

On Tue, Jun 19,

2012 at 5:51 PM,

wrote:

We as a

profession must be honest with our

assessments.  If we, as an individual

practitioner, feel the patient does

not need care, is malingering or

otherwise, we must report our findings

in our notes.  Do not treat this

patient under the auto insurance if

your findings do not support such

care.  There may always be

chiropractors that turn the other

cheek in order to make a buck, and

unfortunately those are the ones that

give the rest of the profession a bad

name.  If you choose not to see them

based upon your evaluation, send that

information with your exam bill to the

insurance adjuster.  They will likely

use that information later to close

the case, if it is well documented.

Requesting an IME does not need to go

through the insurance company though.

 You may request a second opinion from

another chiropractor asking them

specifically if there are injuries

from this crash that need ongoing

treatment.  Hopefully you choose

someone honest and ethical and they

will give an appropriate response.

But most importantly, do not treat

someone you do not feel needs it.

dan miller dc

On Jun 19, 2012, at 5:24 PM, kelly

wrote:

> I recently voiced my concerns

about a similar patient so called his

adjuster and requested an IME. I was

laughed at. I was very careful with

what I said about the patient, but

basically that the subjective info did

not correlate with the objective

findings and that I did not feel

further care was necessary. Luckily, I

had plenty of documentaion to support

this. Turns out he found another DC

who was happy to continue months and

months of additional treatment. But, I

washed my hands of him.

>

> Am curious as to how others

handle these situations.

>

> Best of luck,

> Barrett

>

> Sent from my Verizon Wireless

BlackBerry

>

> Sender: oregondcs

> Date: Wed, 20 Jun 2012 00:04:37

-0000

> To: <oregondcs >

> Subject:

requesting IME-legal please chime in

>

>

> dear listserve,

>

> I just got a new MVA pt who has

been seen from 2 other practioners.

Pt's symptoms do not correlate with

physical exam findings and there is

generally an appearance of

malingering- pt dislikes her job,

there is marital dichord and the pt is

deconditioned- Pt's accident was

almost 4 months ago, "bump" in the

parking lot kind of thing-with

resulting severe neuro deficits,

exaggarated muscle weakness,etc....

Xrays were ordered from another

practioner, all were negative.

>

> Question-can I quietly hint or

request an IME? this is a new one for

me- personally, I do not want to treat

for more than a couple of visits

>

> Legally, what are my

responsibilities regarding putting an

end to this and what might the

repercussions be?

>

> Thanks

>

> Babbbitt, Forest Grove

Health and Fitness

>

>

>

------------------------------------

All posts must adhere to OregonDCs

rules located on homepage at: http://groups.yahoo.com/group/oregondcs/

Tell a colleague about OregonDCs!

(must be licensed Oregon DC)Yahoo!

Groups Links

<*> To visit your group on the

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[Guest guest]

Franchesca,

Re: “That diagnosis requires a psychological component which is not in our scope to make.”

As primary care physicians, we are trained to comment on the patient’s “affect” (their general appearance and what it communicates), and to comment on discrepancies between subjective and objective findings. In fact, because of our experience in traumatic injury history taking, we are better qualified in some ways than many psychologists.

(And regarding being a bit cocky about our skills: who do you want managing your loved one’s traumatic injuries, someone who thinks he’s a pulp cutter?)

Speaking of cocky, there’s the maxim that my wise Chinese uncle used to repeat....nevermind.

That being said, we should always weasel, I mean equivocate and “suggest” further evaluation to determine the patient’s historical accuracy, and so on.

--

E. Abrahamson, D.C.

Chiropractic physician

Lake Oswego Chiropractic Clinic

315 Second Street

Lake Oswego, OR 97034

Website: http://www.lakeoswegochiro.com

Date: Wed, 20 Jun 2012 12:04:03 -0700

To: 'Oregon DC's' <oregondcs >

Subject: requesting IME-legal please chime in

It is important to not state the patient is malingering. That diagnosis requires a psychological component which is not in our scope to make. If the patient states flat out, " I am making this up to recieve more care or obtain disability " then you can chart that and show them to the door.

It is better to state symptoms to not match findings or that the patient seems to be a symptom magnifier. There is also nothing wrong with tell the patient you cannot find anything which points to their symptoms. You can let them know you need a second opion or that you do not think you are the doctor to help them out. We will have to have difficult coversations from time to time. It is important not to cater to the patient but do what is best for them, even if that means they do not need care at this time.

Respectfully,

Franchesca Vermillion, DC

Vermillion & Bloom, PC

Balance & Fitness through

Chiropractic Rehabilitation

1750 Blankenship Rd Ste 295

West Linn, OR 97068

www.vermillionbloom.com

To: portlandchiro1@...; danm@...

CC: kellybpdx@...; dr.babbitt@...; oregondcs

From: drbob@...

Date: Tue, 19 Jun 2012 21:27:30 -0700

Subject: RE: ****SPAM**** Re: requesting IME-legal please chime in

USE OF THE VARIOUS MALINGERING TESTS AS WELL AS PRESSURE SENSITIVE QUANTIATIVE TESTING OF THE AREAS OF COMPLAINT. (REPEAT TWICE AND COMPARE THE NUMBERS)

bOB

W. Pfeiffer, D.C., D.A.B.C.O.

Lee Pfeiffer, R.N., B.S.

46 N.E. Mt. Hebron Dr. (no USPS mail)

P.O. Box 606

Pendleton, OR 97801

drbob@...

leernbs@...

All people smile in the same language

From: oregondcs [mailto:oregondcs ] On Behalf Of Schneider

Sent: Tuesday, June 19, 2012 8:55 PM

To:

Cc: kellybpdx@...; dr.babbitt; oregondcs

Subject: Re: ****SPAM**** Re: requesting IME-legal please chime in

I too had a suspicious patient who I had doubts about recently. I referred patient to Dr. Saboe and the situation was handled quite professionally . I would agree with Dr. 's sound advice-and send this suspicious patient to a trustworthy DC who can do an IME. I would highly recommend Dr. Saboe.

Schneider DC

PDX

We as a profession must be honest with our assessments. If we, as an individual practitioner, feel the patient does not need care, is malingering or otherwise, we must report our findings in our notes. Do not treat this patient under the auto insurance if your findings do not support such care. There may always be chiropractors that turn the other cheek in order to make a buck, and unfortunately those are the ones that give the rest of the profession a bad name. If you choose not to see them based upon your evaluation, send that information with your exam bill to the insurance adjuster. They will likely use that information later to close the case, if it is well documented.

Requesting an IME does not need to go through the insurance company though. You may request a second opinion from another chiropractor asking them specifically if there are injuries from this crash that need ongoing treatment. Hopefully you choose someone honest and ethical and they will give an appropriate response.

But most importantly, do not treat someone you do not feel needs it.

dan miller dc

> I recently voiced my concerns about a similar patient so called his adjuster and requested an IME. I was laughed at. I was very careful with what I said about the patient, but basically that the subjective info did not correlate with the objective findings and that I did not feel further care was necessary. Luckily, I had plenty of documentaion to support this. Turns out he found another DC who was happy to continue months and months of additional treatment. But, I washed my hands of him.

>

> Am curious as to how others handle these situations.

>

> Best of luck,

> Barrett

>

> Sent from my Verizon Wireless BlackBerry

>

> Sender: oregondcs

> Date: Wed, 20 Jun 2012 00:04:37 -0000

> To: <oregondcs >

> Subject: requesting IME-legal please chime in

>

>

> dear listserve,

>

> I just got a new MVA pt who has been seen from 2 other practioners. Pt's symptoms do not correlate with physical exam findings and there is generally an appearance of malingering- pt dislikes her job, there is marital dichord and the pt is deconditioned- Pt's accident was almost 4 months ago, " bump " in the parking lot kind of thing-with resulting severe neuro deficits, exaggarated muscle weakness,etc.... Xrays were ordered from another practioner, all were negative.

>

> Question-can I quietly hint or request an IME? this is a new one for me- personally, I do not want to treat for more than a couple of visits

>

> Legally, what are my responsibilities regarding putting an end to this and what might the repercussions be?

>

> Thanks

>

> Babbbitt, Forest Grove Health and Fitness

>

>

>

------------------------------------

All posts must adhere to OregonDCs rules located on homepage at: http://groups.yahoo.com/group/oregondcs/

Tell a colleague about OregonDCs! (must be licensed Oregon DC)

[Guest guest]

Using the actual term 'malingering' is what I caution not using.

Yes we were taught malingering tests but the actual definition

has to do with over exaggerating symptoms in oder to obtain

secondary gain.

That is the pyschological part I caution about. To state

'Patient is malingering' means we know the reason why they

are over stating symptoms or why symptoms dont match up.

It could put us in a position of defamation of character.

Unless the patient actually states, "Yes I am faking my symptoms

to obtain disabiliy or to avoid going back to work" then using

the term Malingering is not appropriate.

I am all for reporting that objective findings do not match patient

complaint or reporting the results of the various

malingering tests. I would just caution how it is written.

If one of the attorneys wants to weight in on this, I would like

to hear it. Maybe I am off base but that is how I learned to chart

it and that is what has been brought up working at Outside In

where we often have people come to us seeking disability.

Some honestly are disabled and others we just cant figure out

what is going on between what they report and what we find.

Respectfully, Franchesca Vermillion, DCVermillion & Bloom, PCBalance & Fitness throughChiropractic Rehabilitation1750 Blankenship Rd Ste 295West Linn, OR 97068www.vermillionbloom.com

Date: Fri, 22 Jun 2012 08:58:57 -0700Subject: Re: requesting IME-legal please chime inFrom: drscott@...To: dr-harper@...; oregondcs Franchesca,Re: “That diagnosis requires a psychological component which is not in our scope to make.”As primary care physicians, we are trained to comment on the patient’s “affect” (their general appearance and what it communicates), and to comment on discrepancies between subjective and objective findings. In fact, because of our experience in traumatic injury history taking, we are better qualified in some ways than many psychologists.(And regarding being a bit cocky about our skills: who do you want managing your loved one’s traumatic injuries, someone who thinks he’s a pulp cutter?)Speaking of cocky, there’s the maxim that my wise Chinese uncle used to repeat....nevermind.That being said, we should always weasel, I mean equivocate and “suggest” further evaluation to determine the patient’s historical accuracy, and so on.-- E. Abrahamson, D.C.Chiropractic physicianLake Oswego Chiropractic Clinic315 Second StreetLake Oswego, OR 97034Website: http://www.lakeoswegochiro.com

Date: Wed, 20 Jun 2012 12:04:03 -0700To: 'Oregon DC's' <oregondcs >Subject: requesting IME-legal please chime in It is important to not state the patient is malingering. That diagnosis requires a psychological component which is not in our scope to make. If the patient states flat out, " I am making this up to recieve more care or obtain disability" then you can chart that and show them to the door. It is better to state symptoms to not match findings or that the patient seems to be a symptom magnifier. There is also nothing wrong with tell the patient you cannot find anything which points to their symptoms. You can let them know you need a second opion or that you do not think you are the doctor to help them out. We will have to have difficult coversations from time to time. It is important not to cater to the patient but do what is best for them, even if that means they do not need care at this time. Respectfully,Franchesca Vermillion, DCVermillion & Bloom, PCBalance & Fitness throughChiropractic Rehabilitation1750 Blankenship Rd Ste 295West Linn, OR 97068www.vermillionbloom.com

To: portlandchiro1@...; danm@...CC: kellybpdx@...; dr.babbitt@...; oregondcs From: drbob@...Date: Tue, 19 Jun 2012 21:27:30 -0700Subject: RE: ****SPAM**** Re: requesting IME-legal please chime in USE OF THE VARIOUS MALINGERING TESTS AS WELL AS PRESSURE SENSITIVE QUANTIATIVE TESTING OF THE AREAS OF COMPLAINT. (REPEAT TWICE AND COMPARE THE NUMBERS)bOB W. Pfeiffer, D.C., D.A.B.C.O.Lee Pfeiffer, R.N., B.S.46 N.E. Mt. Hebron Dr. (no USPS mail)P.O. Box 606 Pendleton, OR 97801drbob@...leernbs@...All people smile in the same languageFrom: oregondcs [mailto:oregondcs ] On Behalf Of SchneiderSent: Tuesday, June 19, 2012 8:55 PMTo: Cc: kellybpdx@...; dr.babbitt; oregondcs Subject: Re: ****SPAM**** Re: requesting IME-legal please chime in I too had a suspicious patient who I had doubts about recently. I referred patient to Dr. Saboe and the situation was handled quite professionally . I would agree with Dr. 's sound advice-and send this suspicious patient to a trustworthy DC who can do an IME. I would highly recommend Dr. Saboe. Schneider DCPDXWe as a profession must be honest with our assessments. If we, as an individual practitioner, feel the patient does not need care, is malingering or otherwise, we must report our findings in our notes. Do not treat this patient under the auto insurance if your findings do not support such care. There may always be chiropractors that turn the other cheek in order to make a buck, and unfortunately those are the ones that give the rest of the profession a bad name. If you choose not to see them based upon your evaluation, send that information with your exam bill to the insurance adjuster. They will likely use that information later to close the case, if it is well documented.Requesting an IME does not need to go through the insurance company though. You may request a second opinion from another chiropractor asking them specifically if there are injuries from this crash that need ongoing treatment. Hopefully you choose someone honest and ethical and they will give an appropriate response.But most importantly, do not treat someone you do not feel needs it.dan miller dc> I recently voiced my concerns about a similar patient so called his adjuster and requested an IME. I was laughed at. I was very careful with what I said about the patient, but basically that the subjective info did not correlate with the objective findings and that I did not feel further care was necessary. Luckily, I had plenty of documentaion to support this. Turns out he found another DC who was happy to continue months and months of additional treatment. But, I washed my hands of him.>> Am curious as to how others handle these situations.>> Best of luck,> Barrett>> Sent from my Verizon Wireless BlackBerry> > Sender: oregondcs > Date: Wed, 20 Jun 2012 00:04:37 -0000> To: <oregondcs >> Subject: requesting IME-legal please chime in>>> dear listserve,>> I just got a new MVA pt who has been seen from 2 other practioners. Pt's symptoms do not correlate with physical exam findings and there is generally an appearance of malingering- pt dislikes her job, there is marital dichord and the pt is deconditioned- Pt's accident was almost 4 months ago, "bump" in the parking lot kind of thing-with resulting severe neuro deficits, exaggarated muscle weakness,etc.... Xrays were ordered from another practioner, all were negative.>> Question-can I quietly hint or request an IME? this is a new one for me- personally, I do not want to treat for more than a couple of visits>> Legally, what are my responsibilities regarding putting an end to this and what might the repercussions be?>> Thanks>> Babbbitt, Forest Grove Health and Fitness>>>------------------------------------All posts must adhere to OregonDCs rules located on homepage at: http://groups.yahoo.com/group/oregondcs/Tell a colleague about OregonDCs! (must be licensed Oregon DC)

[Guest guest]

I absolutely agree. The work comp IME doctors are so willing to put this into their reports, when in reality many patient truly are injury and have their symptoms neglected they are describing, especially when it comes to head injuries. By making this God like statement will allow those at the insurance companies to jump on it, so they don't have to take financial responsibly any longer, it does not matter if you are right or wrong they will use your report to destroy the patients ability to seek further help, if they really need it.Walt

Eagle Point

> I recently voiced my concerns about a similar patient so called his adjuster and requested an IME. I was laughed at. I was very careful with what I said about the patient, but basically that the subjective info did not correlate with the objective findings and that I did not feel further care was necessary. Luckily, I had plenty of

documentaion to support this. Turns out he found another DC who was happy to continue months and months of additional treatment. But, I washed my hands of him.>> Am curious as to how others handle these situations.>> Best of luck,> Barrett>> Sent from my Verizon Wireless BlackBerry> > Sender: oregondcs > Date: Wed, 20 Jun 2012 00:04:37 -0000> To: <oregondcs >> Subject: requesting IME-legal please chime in>>> dear listserve,>> I just got a new MVA pt who has been seen from 2 other practioners. Pt's symptoms do

not correlate with physical exam findings and there is generally an appearance of malingering- pt dislikes her job, there is marital dichord and the pt is deconditioned- Pt's accident was almost 4 months ago, "bump" in the parking lot kind of thing-with resulting severe neuro deficits, exaggarated muscle weakness,etc.... Xrays were ordered from another practioner, all were negative.>> Question-can I quietly hint or request an IME? this is a new one for me- personally, I do not want to treat for more than a couple of visits>> Legally, what are my responsibilities regarding putting an end to this and what might the repercussions be?>> Thanks>> Babbbitt, Forest Grove Health and Fitness>>>------------------------------------All posts must adhere to OregonDCs rules located on homepage at: http://groups.yahoo.com/group/oregondcs/Tell a colleague about OregonDCs! (must be licensed Oregon DC)

[Guest guest]

Doctors,

This is obviously a very sensitive issue. Any patient who is faking his or her

symptoms is wasting your time and making you an unwitting party to fraud. If

they are discovered, the fact you treated them feeds into very powerful negative

stereotypes about your profession that indirectly harms you and your fellow

professionals. As a plaintiff's lawyer, a lying client presents the very same

threats to me and my profession.

With all of that said, I would caution you against noting that a patient lied to

you unless you are certain the patient has done so. Quite simply, you are

acting as judge, jury and executioner, because such a note will surely end any

benefits a patient is receiving and will kill any case they may have against a

third party. I have not reviewed the case law, but I agree with Dr. Vermillion

that making a quasi-psychological diagnosis that a patient is lying could

potentially expose a chiropractor to a lawsuit.

I do not mean to say that any of us should coddle persons we strongly suspect of

lying. I liked Dr. Grice's approach to the issue:

" Personally, I think the best route is to just document Subjective and Objective

complaints, make your professional comment that you don't see the need for any

further care since the two don't match up, and then release the patient from

care. Once the adjuster sees the notation, and the fact that the patient has

now moved on to another provider, they will order an IME if they are worth two

cents. "

Saying " subjective complaints don't match objective findings " is something an

adjuster or defense lawyer is going to have no problem understanding the meaning

of, and it has the benefit of being unassailably clinically true. Remember,

truth is always a defense to defamation. If you were sued, it's a lot easier to

prove the truth of " subjective complaints aren't supported by objective

findings " than " I don't believe this patient is being truthful about her

symptoms or how she came by them, " or " I have concluded this person is lying or

exaggerating to get money. "

Regardless of how you handle the problem, if the patient is working with an

attorney, PLEASE call the attorney and let them know you have doubts about the

patient's veracity. An ethical attorney will investigate and likely terminate

the representation if your suspicions appear grounded - we don't want to waste

our time helping liars either.

Hope this helps!

Respectfully,

Ben

>

> Using the actual term 'malingering' is what I caution not using.

> Yes we were taught malingering tests but the actual definition

> has to do with over exaggerating symptoms in oder to obtain

> secondary gain.

>

> That is the pyschological part I caution about. To state

> 'Patient is malingering' means we know the reason why they

> are over stating symptoms or why symptoms dont match up.

> It could put us in a position of defamation of character.

>

> Unless the patient actually states, " Yes I am faking my symptoms

> to obtain disabiliy or to avoid going back to work " then using

> the term Malingering is not appropriate.

>

> I am all for reporting that objective findings do not match patient

> complaint or reporting the results of the various

> malingering tests. I would just caution how it is written.

>

> If one of the attorneys wants to weight in on this, I would like

> to hear it. Maybe I am off base but that is how I learned to chart

> it and that is what has been brought up working at Outside In

> where we often have people come to us seeking disability.

> Some honestly are disabled and others we just cant figure out

> what is going on between what they report and what we find.

>

>

>

> Respectfully,

>

> Franchesca Vermillion, DC

> Vermillion & Bloom, PC

> Balance & Fitness through

> Chiropractic Rehabilitation

> 1750 Blankenship Rd Ste 295

> West Linn, OR 97068

>

> www.vermillionbloom.com

>

>

>

>

>

>

>

> Date: Fri, 22 Jun 2012 08:58:57 -0700

> Subject: Re: requesting IME-legal please chime in

> From: drscott@...

> To: dr-harper@...; oregondcs

>

> Franchesca,

> Re: “That diagnosis requires a psychological component which is not in our

scope to make.”

> As primary care physicians, we are trained to comment on the patient’s

“affect” (their general appearance and what it communicates), and to comment on

discrepancies between subjective and objective findings. In fact, because of our

experience in traumatic injury history taking, we are better qualified in some

ways than many psychologists.

>

> (And regarding being a bit cocky about our skills: who do you want managing

your loved one’s traumatic injuries, someone who thinks he’s a pulp cutter?)

> Speaking of cocky, there’s the maxim that my wise Chinese uncle used to

repeat....nevermind.

>

> That being said, we should always weasel, I mean equivocate and “suggest”

further evaluation to determine the patient’s historical accuracy, and so on.

>

> --

> E. Abrahamson, D.C.

> Chiropractic physician

> Lake Oswego Chiropractic Clinic

> 315 Second Street

> Lake Oswego, OR 97034

>

> Website: http://www.lakeoswegochiro.com

>

> <image.jpg>

>

>

>

> Date: Wed, 20 Jun 2012 12:04:03 -0700

> To: 'Oregon DC's' <oregondcs >

> Subject: requesting IME-legal please chime in

>

>

>

>

>

>

> It is important to not state the patient is malingering. That diagnosis

requires a psychological component which is not in our scope to make. If the

patient states flat out, " I am making this up to recieve more care or obtain

disability " then you can chart that and show them to the door.

>

> It is better to state symptoms to not match findings or that the patient seems

to be a symptom magnifier. There is also nothing wrong with tell the patient you

cannot find anything which points to their symptoms. You can let them know you

need a second opion or that you do not think you are the doctor to help them

out. We will have to have difficult coversations from time to time. It is

important not to cater to the patient but do what is best for them, even if that

means they do not need care at this time.

>

>

>

> Respectfully,

>

> Franchesca Vermillion, DC

> Vermillion & Bloom, PC

> Balance & Fitness through

> Chiropractic Rehabilitation

> 1750 Blankenship Rd Ste 295

> West Linn, OR 97068

>

> www.vermillionbloom.com

>

>

>

>

>

>

>

> To: portlandchiro1@...; danm@...

> CC: kellybpdx@...; dr.babbitt@...; oregondcs

> From: drbob@...

> Date: Tue, 19 Jun 2012 21:27:30 -0700

> Subject: RE: ****SPAM**** Re: requesting IME-legal please

chime in

>

>

> USE OF THE VARIOUS MALINGERING TESTS AS WELL AS PRESSURE SENSITIVE QUANTIATIVE

TESTING OF THE AREAS OF COMPLAINT. (REPEAT TWICE AND COMPARE THE NUMBERS)

>

>

>

> bOB

>

>

>

> W. Pfeiffer, D.C., D.A.B.C.O.

>

> Lee Pfeiffer, R.N., B.S.

>

> 46 N.E. Mt. Hebron Dr. (no USPS mail)

>

> P.O. Box 606

>

> Pendleton, OR 97801

>

> drbob@...

>

> leernbs@...

>

>

>

>

>

> All people smile in the same language

>

>

>

> From: oregondcs [mailto:oregondcs ] On Behalf

Of Schneider

> Sent: Tuesday, June 19, 2012 8:55 PM

> To:

> Cc: kellybpdx@...; dr.babbitt; oregondcs

> Subject: Re: ****SPAM**** Re: requesting IME-legal please

chime in

>

>

>

>

>

> I too had a suspicious patient who I had doubts about recently. I referred

patient to Dr. Saboe and the situation was handled quite professionally . I

would agree with Dr. 's sound advice-and send this suspicious patient to a

trustworthy DC who can do an IME. I would highly recommend Dr. Saboe.

>

> Schneider DC

> PDX

> On Tue, Jun 19, 2012 at 5:51 PM,

wrote:

>

> We as a profession must be honest with our assessments. If we, as an

individual practitioner, feel the patient does not need care, is malingering or

otherwise, we must report our findings in our notes. Do not treat this patient

under the auto insurance if your findings do not support such care. There may

always be chiropractors that turn the other cheek in order to make a buck, and

unfortunately those are the ones that give the rest of the profession a bad

name. If you choose not to see them based upon your evaluation, send that

information with your exam bill to the insurance adjuster. They will likely use

that information later to close the case, if it is well documented.

>

> Requesting an IME does not need to go through the insurance company though.

You may request a second opinion from another chiropractor asking them

specifically if there are injuries from this crash that need ongoing treatment.

Hopefully you choose someone honest and ethical and they will give an

appropriate response.

>

> But most importantly, do not treat someone you do not feel needs it.

>

> dan miller dc

>

>

>

> > I recently voiced my concerns about a similar patient so called his adjuster

and requested an IME. I was laughed at. I was very careful with what I said

about the patient, but basically that the subjective info did not correlate with

the objective findings and that I did not feel further care was necessary.

Luckily, I had plenty of documentaion to support this. Turns out he found

another DC who was happy to continue months and months of additional treatment.

But, I washed my hands of him.

> >

> > Am curious as to how others handle these situations.

> >

> > Best of luck,

> > Barrett

> >

> > Sent from my Verizon Wireless BlackBerry

> >

> > Sender: oregondcs

> > Date: Wed, 20 Jun 2012 00:04:37 -0000

> > To: <oregondcs >

> > Subject: requesting IME-legal please chime in

> >

> >

> > dear listserve,

> >

> > I just got a new MVA pt who has been seen from 2 other practioners. Pt's

symptoms do not correlate with physical exam findings and there is generally an

appearance of malingering- pt dislikes her job, there is marital dichord and the

pt is deconditioned- Pt's accident was almost 4 months ago, " bump " in the

parking lot kind of thing-with resulting severe neuro deficits, exaggarated

muscle weakness,etc.... Xrays were ordered from another practioner, all were

negative.

> >

> > Question-can I quietly hint or request an IME? this is a new one for me-

personally, I do not want to treat for more than a couple of visits

> >

> > Legally, what are my responsibilities regarding putting an end to this and

what might the repercussions be?

> >

> > Thanks

> >

> > Babbbitt, Forest Grove Health and Fitness

> >

> >

> >

>

>

>

> ------------------------------------

>

> All posts must adhere to OregonDCs rules located on homepage at:

http://groups.yahoo.com/group/oregondcs/

> Tell a colleague about OregonDCs! (must be licensed Oregon DC)Yahoo! Groups

Links

>

>

>

>

>

>

> --

> Schneider DC

> PDX

>

>

>

>

>

>

>

>

>

--

Ben

Attorney at Law

1205 NW 25th Avenue

Portland, OR 97210

p.

f.

e. Ben@...

w. coxlawpdx.com

[Guest guest]

Thanks for your thoughtful response Ben.    I handled a PI case recently just as you and Ron suggested and indeed an IME was requested and the case was simply terminated. Schneider DCPDX

Doctors,

This is obviously a very sensitive issue.  Any patient who is faking his or her symptoms is wasting your time and making you an unwitting party to fraud.  If they are discovered, the fact you treated them feeds into very powerful negative stereotypes about your profession that indirectly harms you and your fellow professionals.  As a plaintiff's lawyer, a lying client presents the very same threats to me and my profession.

With all of that said, I would caution you against noting that a patient lied to you unless you are certain the patient has done so.  Quite simply, you are acting as judge, jury and executioner, because such a note will surely end any benefits a patient is receiving and will kill any case they may have against a third party.  I have not reviewed the case law, but I agree with Dr. Vermillion that making a quasi-psychological diagnosis that a patient is lying could potentially expose a chiropractor to a lawsuit.

I do not mean to say that any of us should coddle persons we strongly suspect of lying.  I liked Dr. Grice's approach to the issue:

" Personally, I think the best route is to just document Subjective and Objective complaints, make your professional comment that you don't see the need for any further care since the two don't match up, and then release the patient from care.  Once the adjuster sees the notation, and the fact that the patient has now moved on to another provider, they will order an IME if they are worth two cents. "

Saying " subjective complaints don't match objective findings " is something an adjuster or defense lawyer is going to have no problem understanding the meaning of, and it has the benefit of being unassailably clinically true.  Remember, truth is always a defense to defamation.  If you were sued, it's a lot easier to prove the truth of " subjective complaints aren't supported by objective findings " than " I don't believe this patient is being truthful about her symptoms or how she came by them, " or " I have concluded this person is lying or exaggerating to get money. "

Regardless of how you handle the problem, if the patient is working with an attorney, PLEASE call the attorney and let them know you have doubts about the patient's veracity.  An ethical attorney will investigate and likely terminate the representation if your suspicions appear grounded - we don't want to waste our time helping liars either.

Hope this helps!

Respectfully,

Ben

>

> Using the actual term 'malingering' is what I caution not using.

> Yes we were taught malingering tests but the actual definition

> has to do with over exaggerating symptoms in oder to obtain

> secondary gain.

>

> That is the pyschological part I caution about. To state

> 'Patient is malingering' means we know the reason why they

> are over stating symptoms or why symptoms dont match up.

> It could put us in a position of defamation of character.

>

> Unless the patient actually states, " Yes I am faking my symptoms

> to obtain disabiliy or to avoid going back to work " then using

> the term Malingering is not appropriate.

>

> I am all for reporting that objective findings do not match patient

> complaint or reporting the results of the various

> malingering tests. I would just caution how it is written.

>

> If one of the attorneys wants to weight in on this, I would like

>  to hear it. Maybe I am off base but that is how I learned to chart

> it and that is what has been brought up working at Outside In

> where we often have people come to us seeking disability.

> Some honestly are disabled and others we just cant figure out

> what is going on between what they report and what we find.

>

>

>

> Respectfully,

>

> Franchesca Vermillion, DC

> Vermillion & Bloom, PC

> Balance & Fitness through

> Chiropractic Rehabilitation

> 1750 Blankenship Rd Ste 295

> West Linn, OR 97068

>

> www.vermillionbloom.com

>

>

>

>

>

>

>

> Date: Fri, 22 Jun 2012 08:58:57 -0700

> Subject: Re: requesting IME-legal please chime in

> From: drscott@...

> To: dr-harper@...; oregondcs

>

> Franchesca,

> Re: “That diagnosis requires a psychological component which is not in our scope to make.”

> As primary care physicians, we are trained to comment on the patient’s “affect” (their general appearance and what it communicates), and to comment on discrepancies between subjective and objective findings. In fact, because of our experience in traumatic injury history taking, we are better qualified in some ways than many psychologists.

>

> (And regarding being a bit cocky about our skills: who do you want managing your loved one’s traumatic injuries, someone who thinks he’s a pulp cutter?)

> Speaking of cocky, there’s the maxim that my wise Chinese uncle used to repeat....nevermind.

>

> That being said, we should always weasel, I mean equivocate and “suggest” further evaluation to determine the patient’s historical accuracy,  and so on.

>

> --

> E. Abrahamson, D.C.

> Chiropractic physician

> Lake Oswego Chiropractic Clinic

> 315 Second Street

> Lake Oswego, OR 97034

>

> Website: http://www.lakeoswegochiro.com

>

> <image.jpg>

>

>

>

> Date: Wed, 20 Jun 2012 12:04:03 -0700

> To: 'Oregon DC's' <oregondcs >

> Subject: requesting IME-legal please chime in

>

>

>

>

>

>

> It is important to not state the patient is malingering. That diagnosis requires a psychological component which is not in our scope to make. If the patient states flat out, " I am making this up to recieve more care or obtain disability " then you can chart that and show them to the door.

>

> It is better to state symptoms to not match findings or that the patient seems to be a symptom magnifier. There is also nothing wrong with tell the patient you cannot find anything which points to their symptoms. You can let them know you need a second opion or that you do not think you are the doctor to help them out. We will have to have difficult coversations from time to time. It is important not to cater to the patient but do what is best for them, even if that means they do not need care at this time.

>

>

>

> Respectfully,

>

> Franchesca Vermillion, DC

> Vermillion & Bloom, PC

> Balance & Fitness through

> Chiropractic Rehabilitation

> 1750 Blankenship Rd Ste 295

> West Linn, OR 97068

>

> www.vermillionbloom.com

>

>

>

>

>

>

>

> To: portlandchiro1@...; danm@...

> CC: kellybpdx@...; dr.babbitt@...; oregondcs

> From: drbob@...

> Date: Tue, 19 Jun 2012 21:27:30 -0700

> Subject: RE: ****SPAM**** Re: requesting IME-legal please chime in

>

>

> USE OF THE VARIOUS MALINGERING TESTS AS WELL AS PRESSURE SENSITIVE QUANTIATIVE TESTING OF THE AREAS OF COMPLAINT. (REPEAT TWICE AND COMPARE THE NUMBERS)

>

>

>

> bOB

>

>

>

> W. Pfeiffer, D.C., D.A.B.C.O.

>

> Lee Pfeiffer, R.N., B.S.

>

> 46 N.E. Mt. Hebron Dr. (no USPS mail)

>

> P.O. Box 606

>

> Pendleton, OR 97801

>

> drbob@...

>

> leernbs@...

>

>

>

>

>

> All people smile in the same language

>

>

>

> From: oregondcs [mailto:oregondcs ] On Behalf Of Schneider

> Sent: Tuesday, June 19, 2012 8:55 PM

> To:

> Cc: kellybpdx@...; dr.babbitt; oregondcs

> Subject: Re: ****SPAM**** Re: requesting IME-legal please chime in

>

>

>

>

>

> I too had a suspicious patient who I had doubts about recently.  I referred patient to Dr. Saboe and  the situation was handled quite professionally .  I would agree with Dr. 's sound advice-and send this suspicious patient to a trustworthy DC who can do an IME.  I would highly recommend Dr. Saboe.

>

> Schneider DC

> PDX

>

>

> We as a profession must be honest with our assessments.  If we, as an individual practitioner, feel the patient does not need care, is malingering or otherwise, we must report our findings in our notes.  Do not treat this patient under the auto insurance if your findings do not support such care.  There may always be chiropractors that turn the other cheek in order to make a buck, and unfortunately those are the ones that give the rest of the profession a bad name.  If you choose not to see them based upon your evaluation, send that information with your exam bill to the insurance adjuster.  They will likely use that information later to close the case, if it is well documented.

>

> Requesting an IME does not need to go through the insurance company though.  You may request a second opinion from another chiropractor asking them specifically if there are injuries from this crash that need ongoing treatment.  Hopefully you choose someone honest and ethical and they will give an appropriate response.

>

> But most importantly, do not treat someone you do not feel needs it.

>

> dan miller dc

>

>

>

> > I recently voiced my concerns about a similar patient so called his adjuster and requested an IME. I was laughed at. I was very careful with what I said about the patient, but basically that the subjective info did not correlate with the objective findings and that I did not feel further care was necessary. Luckily, I had plenty of documentaion to support this. Turns out he found another DC who was happy to continue months and months of additional treatment. But, I washed my hands of him.

> >

> > Am curious as to how others handle these situations.

> >

> > Best of luck,

> > Barrett

> >

> > Sent from my Verizon Wireless BlackBerry

> >

> > Sender: oregondcs

> > Date: Wed, 20 Jun 2012 00:04:37 -0000

> > To: <oregondcs >

> > Subject: requesting IME-legal please chime in

> >

> >

> > dear listserve,

> >

> > I just got a new MVA pt who has been seen from 2 other practioners. Pt's symptoms do not correlate with physical exam findings and there is generally an appearance of malingering- pt dislikes her job, there is marital dichord and the pt is deconditioned- Pt's accident was almost 4 months ago, " bump " in the parking lot kind of thing-with resulting severe neuro deficits, exaggarated muscle weakness,etc.... Xrays were ordered from another practioner, all were negative.

> >

> > Question-can I quietly hint or request an IME? this is a new one for me- personally, I do not want to treat for more than a couple of visits

> >

> > Legally, what are my responsibilities regarding putting an end to this and what might the repercussions be?

> >

> > Thanks

> >

> > Babbbitt, Forest Grove Health and Fitness

> >

> >

> >

>

>

>

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