Best Practices for the Independent Medical Examination of Mental and Behavioral Disorders

Abstract

Independent medical examinations (IMEs) are elective evaluations of clinical conditions and differ from a clinical consultation in several important ways. They are conducted in many medicolegal contexts and are performed by a regulated health professional who is not the treating health care provider. An IME seeks objective information about the examinee's diagnoses, functional abilities and impairments, and other features relevant to addressing medicolegal-related cases by relying on multiple data sources. Best practice guidelines have been established for the completion of physical IMEs. However, similar mental and behavioral disorder (M&BD) standards are less common, and M&BD IMEs often do not follow a consistent process. This article offers guidance on applying and adapting existing standards to M&BD IMEs. We outlined the appropriate use of psychiatric nomenclature and how to apply recent changes to Chapter 14 of the AMA Guides to the Evaluation of Permanent Impairment. The article further offers a mechanism for introducing greater objectivity into an otherwise subjective process by employing relevant psychological validity testing and conducting a coherence analysis in formulating an opinion. In summary, we provide a synopsis of current best practices and offer the examiner a method for aligning M&BD IMEs with equally high standards of excellence.

The SASOP/PsychMg guidelines for psychiatric independent medical examinations

“…Independent medical examination providers are advised to adhere to a minimum standard of introducing objectivity into the IME process. 8 As stated, the treating psychiatrist should avoid serving as an independent medical examiner on behalf of their patients, as this dual role can be detrimental to the therapeutic relationship. Both treating and independent psychiatrists are encouraged to engage in respectful and professional discussions about examinees, avoiding an adversarial approach and respecting each other’s roles in the process of assessing and managing impairment.…”

“…It is important to note that the term ‘patient’ should not be used to refer to the examinee, as it could imply the existence of a traditional doctor–patient relationship, which is strictly prohibited during the IME process. 8 …”

“…The specific scope of IMEs is shaped by requesting parties’ medical information needs, and IME providers may be asked to provide insights into a range of relevant questions for the cases at hand. 8 …”

“… 8 While the physical health impact of the pandemic appears to be subsiding, the mental and behavioural health consequences may just be emerging. 8 …”

“…It is important to avoid using the term ‘patient’ when referring to the examinee to prevent any confusion with a conventional doctor–patient relationship, which is not permitted during an IME. 8 …”