requesting IME-legal please chime in

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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. 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)