NANOSNET

That was an interesting discussion, last night, regarding what are called IMEs. During the past 40+ years, I've been called on to perform an occasional IME. My preferred term is IMPARTIAL Medical Evaluation, because we always want to be respectful, courteous, and fair with the individual sent to us for an evaluation. For what it's worth, I will describe how this is handled in my office after an exam date is scheduled by the office manager. Sometimes the request is from a plaintive attorney and sometimes it's from a defense attorney.

When I first enter the room, I explain to the individual that they are not my patient, but that I will treat them as though they are my patient. I also ask them to request a copy of my report, because they are entitled to know what people say about them. I reassure them that we are all brothers and sisters, but we don't have to agree with each other - just be fair.

I also let the individual, being examined, know that I sign and date every page of my report, and if they don't see that, it's not my letter it's somebody else's who says it's mine. I started doing this after I found one company, requesting my IME report, simply rewriting the report, and putting my scanned signature at the end of their report.

I ask the individual, being evaluated, to read the report and, if they think something is not right, they should say something. I also ask them to show the letter to their treating physician so that their time in my office is not wasted and they get some benefit from a fair impartial examination.

While attorneys are adversarial, we physicians shouldn't be. Our prime directive is patient advocacy and the goal is to help the individual, being evaluated, see truth and facts about the condition of their vision/eyes. I remember Bill Hoyt once telling me to avoid letting an attorney, at a deposition, force you to respond to or make a judgment on something outside of the field of Neuro-Ophthalmology.

Defense attorneys just want the truth. When a plaintiff attorney asks me to perform an IME, I give them a heads up on my opinion and then ask them if they still want me to write a report.  I try not to make judgments, but simply say something is not what I would do. I have found that the individual(s), who show up in the office for an IME, are sometimes being taken advantage of and/or prescribed medically unnecessary and not medically indicated glasses with prism, because they think and have been told that something is wrong when it is not.

If anyone is interested in more thoughts, please feel free to contact me by personal email and/or phone. Best wishes to all.