Sample Healthcare E-Newsletter
The Challenges of QME, IME Evaluation and Reporting
Back Injuries, Chronic Pain, Malingering
The (QME, IME) frequently confronts complex and interwoven psychophysiological behaviors when evaluating workplace injuries. These cases demand an in-depth use of all of the (QME,IME’s) skills: communications, psychology, forensics and medical evaluation. Further, his report of these behaviors must be unbiased and accessible to lay persons and those in the medical and legal fields. This newsletter describes evaluations and their related data requiring the utmost discernment by the (QME, IME): back injuries, chronic pain, and malingering.
For both employer and employee, back injuries top the list of disastrous workplace injuries. For the (QME IME), back injuries present an intricate medical evaluative challenge.
Back injuries remain common in the workplace. Over one million workers suffer back injuries every year, one in five of all workplace injuries or illnesses. Employees suffer both mentally and physically while industry loses billions in productivity annually.
For the (QME, IME), all back injuries demand astute discrimination. And, if the injury progresses to chronic low back pain, injury and psychiatric symptoms can become elaborately interwoven. A 2008 study by Gunnar B.J. Andersson, M.D., Ph.D., reports that chronic low back pain can be both cause and result of psychiatric symptoms and illness. Furthermore, in his conclusion, Andersson suggests caution when assessing chronic back pain etiology because the reliability and validity of existing data are uncertain. For that reason, the IME must carefully consider the mental status of the patient and any reported pain both pre- and post-injury; the clinical picture is multi-layered and complex.
An intricate connection exists between all types of chronic pain and psychiatric disorders. Patients with chronic pain exhibit symptoms of anxiety, depressive illness and PTSD far greater than the norm. A number of studies show that depression develops in 40% to 80% of patients with chronic pain with the depression being the causative agent. Some studies report 50% of patients who are injured at work have comorbid posttraumatic stress disorder (PTSD) related to the initial work injury trauma. These patients report lower levels of activity, mobility and productivity. They may develop a fear reinjury, further impeding a return to work. For the (QME, IME), also problematic is that the reporting of chronic pain is subjective in nature.
Finally, for the IME who must assess malingering, perhaps in addition to chronic pain or back injury, the patient-client relationship is turned on its head. Traditionally, the patient approaches the clinician in straightforward need of treatment. A malingering assessment distorts that relationship of trust. The patient may view his evaluation as suspect, the relationship as adversarial. Indeed, the behavior of the patient may change, his subjective reports of the illness or injury adjusting consciously or subconsciously to a perceived threat. The (QME, IME) faces yet another hurdle in diagnosis and reporting.
The (QME, IME) is charged with providing accurate and unbiased evaluations and reports on patients with work-related injuries. Yet, the job is neither simple nor clear-cut. As a medical evaluator, he must possess in-depth knowledge of the medical-legal process; as a clinician, he must consider the complex interweave of mind and body symptoms that repeatedly arise from such injuries.
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