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Abstract
The assessment of impairment due to alteration in mental status, cognition, and highest integrative function may be challenging. A review of impairment assessments performed by others can provide valuable insights, including an appreciation of how evaluators may misapply the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Sixth Edition. As a teaching example, this article presents an erroneous rating for a claim of cognitive impairment. The authors point out that most of the misdirection in the case example could be identified with reference to the AMA Guides, Sixth Edition, which reveals discrepancies between the rating processes in this case and actual sixth edition methodology. Nevertheless, the case example involved certain components that were so unconventional that it would have been impossible for the sixth edition contributors to anticipate the need to write a text that would have prevented these errors. The process of sorting out this misdirected rating revealed a previously unanticipated need to clarify sixth edition methodology, and the present article provides such clarification. The concluding section of this article provides a step-by-step protocol for the AMA Guides, Sixth Edition, methodology that involves rating cognitive impairment using Section 13.3d, Mental Status, Cognition, and Highest Integrative Function. The fourteen steps outline a meticulous process based on appropriate clinical assessment, application of evidence-based medicine, and the process outlined in the AMA Guides, Sixth Edition.
- Abstract
- Case Example
- Clarification of the AMA Guides, Sixth Edition, Methodology
- Additional Inconsistencies with AMA Guides, Sixth Edition, Methodology
- Noncredible Approach to Neuropsychology Testing
- A Step-by-Step Simplification of AMA Guides, Sixth Edition, Methodology for Rating Cognitive Impairment in Accordance with Section 13.3d
- Summary
- References
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1.
Rondinelli RD, Brigham CR, Mueller K, et al. (Editors). AMA Guides to the Evaluation of Permanent Impairment, 6th ed. Chicago: American Medical Association; 2009.
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Barth RJ, Brigham CR. Who is in the better position to evaluate, the treating physician or an independent examiner? Guides Newsletter. September–October 2005.
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Greenburg SA, Shuman DW. Irreconcilable conflict between therapeutic and forensic roles. Professional Psychology: Research and Practice. 1997; 28:50–57.
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Greenburg SA, Shuman DW. When worlds collide: therapeutic and forensic roles. Professional Psychology: Research and Practice. 2007; 38:129–132.
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Bailey DS. Should you testify for your client? Mixing forensic and clinical roles creates an ethically sticky situation. Monitor on Psychology. October 2003; 72–73.
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Buck CJ, ed. 2012 ICD-9-CM Professional Edition For Physicians. Chicago: American Medical Association; 2012.
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Buck CJ, ed. 2014 ICD-9-CM Professional Edition For Physicians. Chicago: American Medical Association; 2014.
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American Medical Association. 2016 International Classification of Diseases, Tenth Revision, Clinical Modification. Chicago: American Medical Association; 2015.
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Brigham CR (Editor). The Guides Casebook, 3rd ed. Chicago: American Medical Association; 2009.
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Loring DW, Bauer RM. Testing the limits: cautions and concerns regarding the new Wechsler IQ and memory scales. Neurology. 2010; 74(8):685–90.
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Holdnack JA, Drozdick LW, directors. Advanced Clinical Solutions for the WAIS-IV and WMS-IV. San Antonio, TX: Pearson; 2009.
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Barth RJ. Determining injury-relatedness, work-relatedness, and claim-relatedness. Guides Newsletter. May–June 2012.
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13.
Melhorn JM, Talmage JB, Ackerman WE, Hyman MH. AMA Guides to the Evaluation of Disease and Injury Causation, 2nd ed. Chicago: American Medical Association; 2014.
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