Panel Session: Practical tips re Medical Reports Presented by: Dr Mary Obele, Consultant Occupational Physician mlcoa 7 October 2016

Response to Deputy President Gilchrist Reasonable administrative action IME Report only as good as the referral letter Purpose clearly stated, brief history/chronology of events provided Schedule of questions ‘Basis’ and ‘Explanation’ rules are not well understood Customised vs templated Number of questions – no more than 12-15 maximum! File material List all material provided What and how much?

IME Collateral Information Things to do.. Referral brief – short case summary Reason for referral causation, diagnosis, treatment/recovery pathway, capacity, RTW planning, PIA, FFD Employer reports Sick leave records, medical/capacity certificates, performance management records Job descriptions, task analysis, list of suitable duties Other relevant policy, legislation Code of conduct, performance management policy and practices

IME Collateral Information Accident / incident investigation reports Investigations – X-rays, MRI’s, CT scans etc Treating doctor records Hospital discharge summaries Pharmacy records Other medical reports Factual investigations Surveillance reports +/- video evidence are usually supplied after an initial IME Things to do..

What does an IME include? Detailed history injury/event, symptoms onset, progression, treatment, status, ADL Medical background Relevant medical history, treatment to date, review of clinical studies/imaging Clinical examination findings Summary findings and diagnosis Answers to your schedule of questions

Effective question design Consider the desired outcomes: Is the problem unrelated to work and not affected by work? Is the problem unrelated to work but affected by work? Is the problem unrelated to work but affects the ability to work? Is the problem caused by work?

More Helpful Tips Don’t underestimate the importance of ensuring Examinee has a positive experience attending an IME Properly briefed and given details of appointment (date, time, location) To prevent: arriving late or not at all, arriving anxious, insufficient time allowed for parking and becoming anxious/parking fines “How/when do I get a copy of my report” – most commonly asked question Referral and file material to be sent no later than 5 days before the appointment Consultant does read the file material before hand Time to trouble shoot any issues or clarifications as necessary Conflict of interest, missing paperwork, clarify any instructions etc. Advise whether approval is granted or required if any further testing/imaging is identified as necessary

More Helpful Tips If a particular document is important to the assessment process then make specific reference to it in the relevant question Consider requesting that contact be made with the treating doctor Provides for ‘real time file material’ Engages treating doctor in the IME process Be clear on what you are wanting to achieve however This instruction to be clearly stated in referral letter mlcoa will facilitate the consent process upon arrival Put any special instructions towards the beginning of the referral letter – not at the end

More Helpful Tips Consider need for an integrated assessment (multi-specialty assessment) if require an IME from more than one specialty type Understand the nature and consequence of the changes introduced around the eligibility criteria – when asking questions and when reading the doctors response Pre-existing degeneration and pathology Prior injury Multiple contributors eg. for psychological conditions Competency in this area, for all stakeholders, is still very immature Training is available on ‘How to maximize the benefits of an IME’ Understanding what makes a good referral letter Effective question design File material to provide Understanding why medical opinions differ Pitfalls to avoid Services available once you receive an IME report

Any Questions?