OCTOBER 2019

WHAT’S INSIDE THIS ISSUE

PRESIDENT-ELECT’S NOTE 2

NEED TO KNOW: CMLE 3

CME CALENDAR 4

IME PRACTICE TIPS 5

INTERESTING FINDINGS 6

FELLOWSHIP CRITERIA 6

@IAIMEChicago @iaime_society

IAIME OFFICERS & DIRECTORS

BOARD CHAIRJames L. Williams, MD, FIAIME

PRESIDENTMarjorie L. Eskay-Auerbach, MD, JD,FIAIME (ORS)

VICE PRESIDENT/PRESIDENT-ELECTBarry Gelinas, MD, DC, FIAIME

SECRETARY/TREASURERGary W. Pushkin, MD, FIAIME (ORS)

DIRECTORSFabrice Czarnecki, MD, MPHEdward I. Dagher, MD, FIAIME(PM&R)

Joshua Hasbani, MD, FIAIME

Les Kertay, PH.D., ABPP

Bhavesh Robert J. Pandya, MD,MPH, FACP, FACOEM, FIAIME

Mark Ross, MD

EXECUTIVE DIRECTORSue O’Sullivan

ASSOCIATE EXECUTIVE DIRECTORGina Baxter

REGISTER TODAY FOR IAIME 2020!

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IAIME PRESIDENT-ELECT’S NOTE

IAIME’s mid-year conference in Philadelphia was well-attended and successful. We had many first-time attendees and along with some long-time attendees all remained engaged throughout the conference.The attendees reported that the mid-year conference was a very educational and pearl-filled event.

Up next is our 2020 33rd Annual Conference on January 8-11, 2020, in Austin, TX!

The Board of Directors appreciated and has responded to our membership’s comments and recommendations requesting the diversification of our speakers. I am pleased to report that we have done just that for the upcoming 2020 Annual Conference in Austin.

The focus of the 2020 Annual Conference will be on the Cervical Spine. Our team has worked diligently to attract some phenomenal speakers which include Dr. David Bauer, Dr. Eugene Carragee and Dr. Robert Ferrari to speak in Austin.

Please go here to access the program for the conference.

We are asking all our members to reach out to colleagues and encourage them to attend the 2020 program. We are always open to suggestions for new program topics, so we can ensure an excellent return on your membership and attract new members into our organization.

Looking forward to seeing all you and many first-time attendees in Austin!

Thank you,

Barry Joseph GelinasIAIME President-Elect

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WHAT YOU NEED TO KNOW ABOUT THE CMLE, IAIME’S NEW CERTIFICATION

The CMLE is a NEW certification being offered by IAIME. This exam and certification replace the CEDIR exam and certification for all individuals who wish to certify in the area of MedicoLegal Evaluation. Individuals who pass the CMLE exam will receive the IAIME designation “Certified MedicoLegal Evaluator” (i.e. “CMLE”). Content covered by the 100-question exam is taught through courses and materials provided by IAIME and in the various AMA Guides textbooks. IAIME Review Courses will support study for this new examination. Added qualifications (i.e. in the 4th, 5th, and 6th Edition Guides) are available to those receiving their CMLE certification by way of an additional exam (and fee) testing impairment ratings and rating principles specific to the particular edition. Existing CEDIR holders are grandfathered with CMLE credentials, valid through January 2021. If you wish to receive an updated CMLE certificate (PDF) to replace your CEDIR certificate, click here to submit a request for an updated certificate. Certificates will be issued within 30 days after receipt of the completed request.

What is the CMLE?The CMLE is a certification program issued by IAIME which demonstrates professional competency of practitioners engaged in the medico-legal arena. The CMLE exam assesses history-taking and physical exam performance, test interpretation, causation analysis, medical management of injuries, return to work and activity restrictions, and impairment and disability. The exam also assesses other key areas such as statistics and literature review, opioids, and the psychology of injury and disability. Passing the CMLE exam allows a practitioner to use the designation “Certified MedicoLegal Evaluator” or “CMLE” to denote expertise in the field of medico-legal evaluation. The CMLE is not AMA Guide-edition-specific, but added qualifications for the AMA Guides 4th, 5th, and 6th Edition are available as additional options.

What is the difference between the CMLE and the CEDIR?The CMLE replaces the CEDIR as IAIME’s certification program. Although similar, the programs differ in that the CMLE is not AMA Guide-edition-specific (without added qualifications), the bank of questions has been updated, and the test is now online and “open book.”

What is the cost of the examination?IAIME Member - $475.00Non-Member - $875.00

How can I prepare for the CMLE examination?Participating in IAIME courses, particularly the Mid-Year MedicoLegal Fundamentals Training Course (offered in August 2020), is an excellent preparation for the CMLE exam. Knowledge of the medical evaluation and management of typical injuries seen in workers is helpful, as is knowledge of critical review of literature and principles of evidence-based medicine. The AMA Guides to the Evaluation of Disease and Injury Causation, the AMA Guides to the Evaluation of Work Ability and Return to Work, and the AMA Guides to the Evaluation of Permanent Impairment are great resources as well, though the specifics of impairment rating by edition and for particular conditions are only tested in the “Added Qualifications” exam.

Is the CMLE required for IAIME fellowship?Yes, the CMLE is a fellowship requirement.

What is the duration of the CMLE certification?It is a time-limited certification lasting 3 years.

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WHAT YOU NEED TO KNOW ABOUT THE CMLE, IAIME’S NEW CERTIFICATION continued

What is the Guides Added Qualification?The “Added Qualification” in AMA Guides 4th, 5th, and 6th Edition demonstrates proficiency in Guides impairment rating principles and the impairment rating process for particular conditions, specific to the edition tested. It allows practitioners to have a credential more specific to a jurisdiction and representative of the edition of the Guides used.

Is IAIME membership required to take the CMLE examination?No. Anyone interested in demonstrating their professional competency may apply to take the exam.

IAIME CME CALENDAR

January 8-9, 2020: 2020 IAIME MedicoLegal Institute – The Science, Art and Practice of Medical EvaluationAustin, TXHighlights include workers’ compensation judges giving input on report-writing, cervical spine issues, providing testimony, chronic pain and causation in mental illness. This training offers up to 15.25 CME credits. Click here for more information and to register.

January 10-11, 2020: IAIME Annual Scientific Session and Business MeetingAustin, TXHighlights include neck and back pain, mental health disorders as comorbidity, concussion and headache impairment rating, shoulder disorders and cultural context of IMEsThis training offers up to 10.5 CME credits. Click here for more information and to register.

Click Here to Register

Click Here to Become a Member

Click Here for Registration Brochure

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IAIME PRACTICE TIPS

Useful definitions: malingering, symptom magnification, factitious disorder, somatic symptom disorder… Fabrice Czarnecki, MD, and Les Kertay, PhD, ABPP

MalingeringMalingering is defined in the DSM-5 as the intentional production of false or grossly exaggerated physical or psychological symptoms, for external incentives (such as obtaining drugs, obtaining financial compensation, evading criminal prosecution, avoiding military service). Of interest, malingering was removed from the index in the DSM’s 5th edition, and was removed from the differential of a number of conditions, including somatic symptom disorders, the reasoning for which is not clear. Malingering is not a mental illness, and is instead listed as a “V-code,” meaning a condition that is not a diagnosis but is something that might come to the attention of a clinician. The DSM-5 states that malingering should be strongly suspected in the following situations: Medicolegal context of presentation; marked discrepancy between the individual’s claimed stress or disability and the objective findings and observations; lack of cooperation during the diagnostic evaluation and in complying with prescribed treatment; presence of antisocial personality disorder.

Symptom magnificationSymptom magnification is the exaggeration by a patient of actual symptoms, generally to convince a healthcare provider or another person of the truth of the patient’s claims. Symptom magnification syndrome is “a self-destructive, socially reinforced behavioral response pattern consisting of reports or displays of symptoms which function to control the life circumstances of the sufferer” (Dr. Matheson). The degree to which symptom magnification is deliberate (and therefore a variation on malingering) or a less conscious “cry for help” is a matter of debate. Regardless of motivation, the impact is an exaggerat-ed symptom presentation that complicates appropriate diagnosis and treatment.

Factitious disorderThis DSM-5 diagnosis requires falsification of physical or psychological signs or symptoms, or induction of injury or disease. In factitious disorders, like in malingering, the person intentionally feigns physical or psychological signs or symptoms. The presumed motivation is to assume the sick role (and gaining attention or sympathy). External incentives (such as with malingering) are absent, or play a minimal role.

Somatic symptom disorderThis DSM-5 diagnosis requires one or more chronic somatic symptoms that are distressing or result in significant disruption of daily life. Patients with this diagnosis are not intentionally creating or exaggerat-ing their signs and symptoms, and believe that their symptoms are real. In the DSM-5, several separate categories of somatoform symptoms, including pain disorder, were collapsed into a single category, which some have argued has significantly altered the utility of the diagnosis by making it more vague.

Illness anxiety disorderThis DSM-5 diagnosis, formerly called hypochondriasis, requires preoccupation about having or ac-quiring a serious illness, high level of anxiety about health and absent or minor somatic symptoms. The degree of worry is out of proportion to the nature of any underlying health conditions.

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IAIME PRACTICE TIPS continued

Conversion disorderThis DSM-5 diagnosis requires one or more symptoms of altered voluntary motor or sensory function, which are incompatible with recognized medical condition, cannot be better explained by another med-ical or mental disorders and cause significant distress or functional impairment. In a change from prior definitions (e.g., DSM-IV), a temporal relationship between stressors and worsening symptoms is not required, and there is no longer an exclusion for symptoms that are intentionally produced. Practitioners are encouraged to attempt to find underlying neurological conditions, which some have argued limit the utility of the diagnosis.

Add or CombineEdward Dagher, MD

In the AMA Guides 5th edition, although most impairments are combined, a few impairments are added.

True or False? When 2 or more digits’ impairments are involved, the thumb and digit ratings are con-verted to hand percentages first, then added.

To further your knowledge of impairment rating, and to master the Science, Art and Practice of Medical Evaluation, join us in Austin, TX, on January 8 -11, 2020, for the IAIME 33rd Annual Scientific Session.

INTERESTING FINDINGS FROM THE MEDICAL LITERATURE: CAUSATION ANALYSIS

If you perform causation analyses, here are two must-read references that you can access and down-load for free on the Internet. These documents outline the formal steps involved in the analysis of occupational causation of diseases.

A Guide to the Work-Relatedness of Disease, NIOSH-CDC (January 1979)

ACOEM Practice Guidelines – Work Relatedness (December 2018)

FELLOWSHIP CRITERIA

The requirements to become and remain an IAIME Fellow are the following:

• Attend an IAIME Annual Meeting and/or the IAIME Mid-Year Training Course no less than once every 3 years

• Participation in one additional IAIME Training Course or an equivalent• Possession of a valid and unrestricted professional license• Submission of a current CV• Two letters of recommendation from present IAIME Fellows• Submission of 3 IME case reports (or equivalent) for review• Successful completion of the CMLE exam• Payment of annual fees to maintain membership in good standing

The fellowship is not restricted to physicians. Licensed psychologists and chiropractors may also apply.