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David Langham
and
Marjorie Eskay-Auerbach

credibility in defining terms and agreeing on context. Appearance and Personality Peter O’Toole in the classic film, My Favorite Year 6 delivered an incredulous retort regarding his appearance on a live television show: “I’m not an actor, I’m a movie star!” This illustrated his perspective of the distinction between stage and film and their respective requirements. Similarly, a physician witness once exclaimed, “I’m not a witness, I am a scientist.” That is fair. The epitome of scientific thought is that reliability should be founded upon process, reproducibility

in AMA Guides® Newsletter
Robert J Barth

observation, the results of an observed evaluation cannot be credibly interpreted based on health care science. This leaves the evaluation results without any basis for a scientifically credible analysis. In other words, scientific studies of the effects of observation have reliably indicated that such observation destroys the credibility of the evaluation process, and any subsequent findings. As such, an observed evaluation is a futile exercise at best, and a source of misinformation at worst. The contaminating nature of observation is crucial for the evaluator and all

in AMA Guides® Newsletter
James Robinson
,
Dennis C. Turk
, and
John D. Loeser

vs unratable will affect the way he or she awards impairment after completing PRI assessment (discussed following). When to Use the PRI System As a general rule, a physician should think about PRI whenever he or she performs an impairment evaluation on an individual with a condition that is typically associated with pain, including almost any orthopedic condition and most neurological conditions. However, there are two circumstances in which a physician should not perform a PRI assessment: When the examinee's credibility is so low that the physician

in AMA Guides® Newsletter
Robert J. Barth

criteria that actually are of greater concern. Is the concept in question ambiguous? Is it controversial? Chapter 18 also indicates pain should not be rated when a clinical presentation can be adequately rated in other chapters of the Guides , or when the examinee demonstrates low credibility. The relevance of these issues for CRPS is discussed below. Does CRPS Have a Well-Defined Pathophysiologic Basis? The lack of a well-defined pathophysiologic basis for CRPS is the reason the sidebar reported it is not ratable via Chapter 18. However, the sidebar did not

in AMA Guides® Newsletter
James B. Talmage
,
Jay Blaisdell
,
Marjorie Eskay-Auerbach
, and
Christopher R. Brigham

is felt to be reliable. Patients may be unreliable in reporting complaints 2 and may misattribute their symptoms to a particular event, regardless of whether a causal relationship exists. Physicians performing evaluations need to make judgments of credibility, both with respect to the history of injury and response to treatment, and cite evidence to support their conclusions. Therefore, if a patient is determined to be not credible, it is not possible to distinguish a report of “continued complaints” from that of “occasional complaints”. Patients may seek on

in AMA Guides® Newsletter
Robert J. Barth
and
Robert Haralson III

other possibility that could account for the presentation. 16 Given such considerations, there is an elevated need for a thorough differential diagnostic process. In fact, these considerations indicate that, if a clinician is willing to entertain the concept of CRPS at all, then differential diagnosis must take precedent over diagnostic criteria. Since diagnostic criteria do not actually distinguish CRPS from non-CRPS cases, a comprehensive differential diagnostic process is the only remaining hope of incorporating any credibility into the diagnostic system

in AMA Guides® Newsletter
Christopher R. Brigham
,
Helene Fearon
,
Steven Feinberg
,
Barry Gelinas
,
David Langham
, and
J. Mark Melhorn

and have noted that it appeared as if “only the names were changed….” The credibility decisions are likely to be impacted by such reports. With virtual reports, it is easy to include images of the examinee and/or to illustrate an issue, content from medical records and other documentation, and timelines. Within a virtual environment, reports may be reviewed and edited by others outside of the physician's office. In a virtual world, only electronic PDF reports are issued. Virtual Client Meetings It may be useful to have a virtual meeting with a client to

in AMA Guides® Newsletter
Christopher R. Brigham

Abstract

Physicians who perform impairment evaluations should base their ratings on the objective condition of the patient, along with credible subjective findings. In making interpretations and judgments, examiners have obligations that are distinct from the duty of care as a treating physician. An experienced attending clinician, for example, may be unfamiliar with the correct process of rating impairment or may not feel unbiased in performing the rating. If significant new diagnoses are discovered, the physician has a medical obligation to inform the requesting party and individual about the condition and to recommend or refer for further medical assessment. When the physician is uncertain about which method to use to calculate an impairment rating or if more than one method can accurately be used, the physician should calculate the impairment rating using different alternatives and choose the method or combination of methods that best represents the functional impairment of the individual. The attending physician often is the person most knowledgeable about the injured employee and is encouraged to render the final impairment rating, when possible. Depending on the jurisdiction, examiners may be required to comply with specific constraints and duties regarding the rating. Examiners should not question an individual's integrity but can appropriately comment on the person's credibility.

in AMA Guides® Newsletter
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Paul E. Ruttle
and
Jackson Hole Wyoming

Credibility of Evaluation” (July/August 2007). To me the presence of an observer significantly compromised the credibility of the evaluation. Dr. Barth confirmed this observation. At this time, the majority of my practice consists of evaluating patients for defense firms. Frequently, the plaintiff's attorneys will attempt to inject an observer by videotaping, tape recording or asking that a direct observer be allowed in the evaluation. These efforts have been successfully thwarted using the Guides Newsletter article. Specifically, the contested cases in which an

in AMA Guides® Newsletter
Deborah Rutt
and
Kathyrn Mueller

do not testify. The purpose of this article is to put medical expert witnesses under the spotlight—why they are needed, what they do, and how they can help or hurt a case. Juries, judges, hearing officers, and other fact finders need experts to understand the medical issues in a case and to assist them in decision making. The credibility of medical experts and the weight given to their testimony depends not only on what they know, but perhaps more importantly on how well they convey what they know. Claims and lawsuits seeking compensation for injury or illness

in AMA Guides® Newsletter