Dr. Michael Franchetti: Now, I would like to take a look at you and go through the examination. The examination focused on her injured area is just the neck and back. It is called a problem-focused examination. The first thing I did is palpation of her injured areas, what I am feeling for is tenderness if Amy complaints of pain in those areas. I am also trying to elicit any spasm, involuntary tightening of a muscle to injury. I can actually feel with my fingers down through here.. This little device is medical compass for simply measuring angles of motion. In this case, she had abnormal range of motion of her neck particularly with rotating and bending to the right side, bend over as far as she can, she had abnormal motion of her back to bending, extending backwards and motion to each side as well. It is very important to perform a thorough neurologic examination as well to elicit any signs of any nerve irritation, pinched nerves, or any evidence of a herniated disc. That was the reason behind testing her strength and reflexes and also testing her sensation in both the upper and the lower extremities. I ordered x-rays in Amy’s case, will be called flexion and extension views of her neck and low back area. That will show us any areas of subtle instability in her neck or back. It will also tell me if there is any preexisting arthritis that would contribute to her symptomatology. After I get the x-rays, I go through all the records available to me, summarize her history, summarize my complete physical examination and the x-ray findings and then come up with a conclusion.
Is She or Isn't She ... Injured
In the course of an independent medical examination, the doctor will evaluate a number of issues pertaining to the nature, extent and cause of your injuries. Perhaps the most important of these issues goes to the very heart of many personal injury claims: Is the patient "faking" her symptoms in an effort to cash in on an accident?
To determine whether injury claims are legitimate, the IME doctor looks for what physicians call "non-organic signs" which are inconsistent with the physical evidence obtained during the examination. Because the doctor knows more about human physiology than patients do, he will often ask the patient whether she is experiencing pain under circumstances which should not elicit any pain at all. Combined with inconsistencies in movement and medical history, these factors may lead a doctor to suspect that a patient is exaggerating or even concocting symptoms.
Signs of Suspicion: The Marks of Manipulative Malingerers
During the physical examination, the doctor will check for certain signs that a patient may be faking or exaggerating the injuries claimed in her case:
- Superficial Tenderness
If the skin is exquisitely sensitive and tender superficially, to a light touch or pinch over a wide area beyond the normal distribution of the sensory nerves, the doctor will suspect exaggeration
- The Anatomy Anomaly
If the anatomical structure is exquisitely sensitive and tender to a deep palpation, over a wide area beyond the anatomic region of the injury, rather than only in the localized area of injury, the doctor will suspect exaggeration
- Head Games
As Dr. Franchetti demonstrated, the examiner will often press lightly on the top of the patient's head and ask if she feels pain in the neck or back. Absent a complete freak of anatomical nature, or fractured skull, "yes" isn't a convincing answer
- The Old Cold Shoulder
The doctor may rotate a standing patient's shoulders and pelvis simultaneously, and ask the patient if this elicits low back pain. But if her skeleton resembles that of most humans, claiming low back pain will raise suspicions as to the patient's honesty
- Distraction Tests
The examiner will check for consistency in the patient's complaints. So if she complains of pain and stiffness in one situation, but denies it while being distracted or exhibits an unrestricted range of motion in the doctor's presence, this rapid chance in symptoms will likely be perceived as phony rather than physical
- Overstated Pain
If the patient takes great pains to claim undue weakness in the absence of objective physical findings, or numbness and tingling over an area which does not correspond to a human nerve structure, these types of "inhuman" claims will lead to suspicion
Overly dramatic moans, cringes or other reactions which are out of proportion to more superficial tests will lead the doctor to suspect malingering