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| Getting Through Your Independent Medical Examination | | Print | |
| Written by Linda Nee | ||||||||||||||||||
Page 5 of 16
Tenderness--the doctor will lightly touch or pinch your skin over a wide area beyond the normal distribution of the sensory nerves. If you say these light touches are sensitive and tender, superficially, the IME physician will suspect exaggeration. If you say you have pain when deeply touched over a wide area beyond the area of an injury or joint, the doctor will suspect exaggeration. Usually pain is only evident in the localized area of the injury. If you have fibromyalgia and say you have pain "everywhere", or "my whole body hurts" the doctor will suspect you are magnifying the symptoms. (Fibromyalgia doesn't hurt all over anyway. It hurts in 18 very specific "tender" or "trigger point locations on the body.") Simulation Tests--If the doctor presses down on your head while you are standing (axial loading), and you report low back pain, the doctor will say you are exaggerating. If the doctor rotates your shoulders and pelvis at the same time while standing and you are complaining of low back pain, the doctor will say you are exaggerating. Distraction Tests--On occasion when the IME physician finds something wrong, he/she may distract you, performing another test of the same area without telling you why. If you have a negative reaction, or don't give a full effort, the doctor will suspect exaggeration. An example of this is to ask the patient to raise one leg against resistance while lying down. If your opposite leg does not press down, for leverage, then the doctors suspects you are not giving full effort for the purpose of exaggeration. Sometimes, the IME physicians will just walk away from you supposedly to write something down in your chart, and then quickly ask you a question. If you "turn your head" in his direction when you told him you couldn't do that because of pain, the doctor will suspect all of your complaints. In most instances, the doctor has already examined you for movement in that area, causing you to believe the exam was completed. Regional Disturbances--If you complain of excessive weakness, such as the giving way of muscles within a particular group, the doctor will say you are exaggerating. Likewise, if you claim numbness, tingling or pain over an area outside of the distribution where the nerves from the spine lead down the leg into the toes, the doctor may suspect exaggeration. This is especially true for fibromyalgia and chronic fatigue claim. Overreaction--If you cringe, grimace or otherwise show unnatural responses to sensory, motor or reflex tests (all of the above), the doctor may suspect exaggeration. In general, IME physicians consider "Waddell Signs" useful in physical assessment of a patient. A "Waddell" test is positive if the patient demonstrates inconsistent or nonanatomical physical signs in three or more of the five tests.
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