Disclosure and independent medical examinations
CMAJ 1997;156:977
In her recent article "Independent medical examinations and the fuzzy politics of disclosure" (CMAJ 1997;156:73-5 [partial text / en bref]), Dorothy Grant discussed issues concerning independent medical examinations (IMEs). Examinations done in Ontario for patients who have experienced motor-vehicle trauma may serve as a good model for contrasting the effects of disclosure concerning IMEs. Across Canada, an IME may be requested by a third party and the information is therefore controlled by the third party. In Ontario, under the auspices of the Ontario Insurance Commission and no-fault auto insurance, designated assessment centres have been established. A centre is chosen by agreement between the insurance company and the insurer. The centre completes a report that is released not only to the insurer but also to injured parties and their family physicians.
If the centre determines that the injured person does not meet the criteria for disability payments or for a physical impairment that would be compensated, the person knows the basis for the decision. Without this information, the injured person cannot determine whether the decision was fair and the evaluation accurate, or whether the evaluator was in any way misinformed. Knowing that the report will be reviewed by the injured party also makes report writers more accountable by forcing them to demonstrate how they reached their conclusion.
The open-disclosure policy also means that a poorly written report based on erroneous data and insignificant evidence can be refuted by the injured party, allowing for an evaluation process that can be more just. I look forward to more articles on this important and timely topic.
Patrick J. Potter, MD
Chief, Department of Physical Medicine
and Rehabilitation
University of Western Ontario
London, Ont.
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