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

2. 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 maximum!
File material
List all material provided
What and how much?

3. 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

4. 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..

5. 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

6. 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?

7. 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

8. 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

9. 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

10. Any Questions?