Independent Medical Exam and Defense Medical Exam Tips for Certified Legal Nurse Consultants

This is Dale Barnes, Certified Legal Nurse
Consultant. I’ve asked Dale to talk with me today about
independent medical exams or, in some states what are referred to as defense medical exams. Dale, tell us a little bit about the process
of what happens when you’re sitting in on an IME or DME. What’s the process? What’s your role? My role, if I’m there with the plaintiff,
which is what I’m usually there for, is I’m there as their advocate. And I am there to protect them. I’m there to see exactly what their injuries
are. I’m there to record everything so that the
attorney has a very good record of what has taken place. And, when you say record, do you mean audio-record
or document? What’s happening? I do both. Sometimes they don’t allow the audio-recording
but most of the time they do and I audio-record. Sometimes I even video-record. Alright, and there’s an advantage to audio-recording
it because that means the MD or practitioner who is doing the exam can’t dispute what happened
in the room. So that’s a perfect reason to actually record
it. Well that’s true, but it’s also important
to document because in an audio recording you can’t see what’s happening. So if a patient is grimacing, or if the physician
does something that hurts the patient you can’t necessarily hear that on an audio-recording. So that’s why you want to do both. Exactly. I know that you said that you serve as an
advocate if you’re on the plaintiff side. In the CLNC® Certification Program we teach
that when they’re working with attorneys that they’re not there as an advocate. But the IME or DME is a little bit different
because you’re really there, not just as a consultant but actually as a fact witness
to the entire event. And so that’s why it’s appropriate to serve
as an advocate on behalf of that plaintiff. Yes, that’s true. And in addition, if anything inappropriate
is said by the physician, or if he asks or tries to do an exam that isn’t allowed, that’s
where I come in to speak up so that doesn’t happen. So you can step in and intervene on behalf
of that plaintiff because they might not know that the MD’s doing something inappropriate. What do you do differently if you’re on the
defense side? On the defense side I don’t intervene at all. I’m there strictly as an observer to see if
the plaintiff’s issues are really what they’re claiming to be. So you might be able to walk away from that
IME or DME and identify some defenses that can help better defend that case. Absolutely! And primarily, you relate it to the alleged
injuries and damages in the case. Yes, that’s correct. Very good! You might identify causation issues, preexisting
conditions or something of that nature in the exam as well, right? Yes, they’re not supposed to ask about those
things but it happens. I’m sure! Give us a few tips, tell us some of the things
that maybe, I know you’ve been doing this for how many years? Since 1999. Right! So you’ve been doing these exams for decades
now. I know that there’s the obvious tips, but
give us a couple of tips that maybe people who have been doing these exams might not
think about. Well, first of all be prepared. Make sure that you have extra batteries with
you for your tape recorder. I think a lot of the nurses that go do these
exams forget that you can’t see everything on the audio tapes and they forget to take
notes. So I think that’s very, very important. Being a thorough note-taker is a tip. In our office we always say the person who
takes the best notes wins. That’s really true in every aspect of what
we do. Not only in our business but, as you’re saying
with attorneys, in an exam, that’s important. Yes and also I would say to make sure to contact
the attorney afterwards to make sure that the attorney is aware of what transpired right
at that time. So the other thing is that I think a lot of
people forget that if you get to the physician’s office and there’s any sort of an issue or
problem, such as if they make you wait too long. Or one instance I had an interpreter was supposed
be there and wasn’t, walk out and call the attorney. Absolutely. That’s really an important point. One final thing that I want to ask you, is
if you could talk a little bit about your role after the exam. I know potentially you could be called in
as a fact witness. How common is that? For me, not at all. And for me it’s also less common to write
a report but I’m prepared if I’m asked to do so. And there are those occasions when that does
occur so I have to be prepared for that. And I asked you this question because I know
a lot of people get nervous about the possibility of having to testify. Whether it’s as an expert witness or as a
fact witness on behalf of an IME or DME. But I always like people to remember that
95% of these cases don’t go to trial. For that most part that’s going to mean that
in most of these cases they’re not going to get called in to testify. Well they’re not. In addition to that it’s important to know
that if you’re called in as a fact witness they don’t try to trip you up as much. It isn’t as overwhelming as some people see
testifying as an expert. It’s not so much a credibility issue as relaying
facts. That’s a really good point. Thank you Dale. I really appreciate you’re sharing your tips
on DMEs and IMEs with us today. Thank you.

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