Preparing for Medical & Psychological Examinations
There are two types of medical exams that you may be asked to attend: Physical Exams and Mental Exams for Personal Injury and Social Security Cases.
The physical exams are done by doctors who work for the government or insurance agency and generally their loyalty is with them and not with you. That means it is very possible their incentive is to find that there is nothing wrong with you whatsoever, especially if the doctor is paid by an insurance company. However, this is not always the case. Basically, you want to be sure that the doctor has all of your medical records when he/she evaluates you. If they do not have all of your medical records, it can later be argued in court that the exam was not thorough. It is up to the doctor to make sure the medical records were received. It is not up to you to supply medical records, unless ordered to do so. Do not provide the doctor with medical records unless your attorney tells you to do so. Your attorney will provide records if pertinent.
You may want to ask the doctor what medical records he/she was given to review and make notes about what he/she did or did not review when you get home. Tell your attorney what medical records the doctor had to review before the doctor examined you.
You should wear a watch and time the examination. Some doctors only spend 5 minutes with the patient, but write reports looking like they spent hours with the patient. Many doctors come to conclusions that you are not disabled or you are not injured based on a 5 minute evaluation.
Complete the form your attorney will give you and make sure you complete it immediately after the exam.
Other doctors like to imply in their reports that there was nothing wrong with you because you drove yourself to the doctor’s office and therefore, you could not be in any pain and you could not be suffering. They may also write in reports that you showed up for the appointment on time implying you had no difficulty with memory or implying you would have no difficulty getting to work on time.
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Other doctors may write in reports that you were neatly dressed, hair combed, etc. and therefore, you must feel good about yourself in spite of your pain. In other words, there was no obvious evidence you were suffering from any pain. I have also seen reports that say the patient sat in the waiting room for more than a half hour without any evidence of pain. If you need to stand up after sitting in pain, do so. If you use a cane or any other assistive device, make sure you take it with you to your doctor’s appointment. If you have a friend or relative who can drive you to the appointment, make sure you tell the doctor how you got to the appointment and why you could not drive yourself. Many clients cannot drive because they are in too much pain or because they have side effects from their medication that makes them too drowsy to drive.
Other doctors have their staff (a nurse or even a secretary) do the evaluation and the doctor comes in after it is done and asks a few questions just so he/she can bill for the exam. Obviously, this is not a comprehensive evaluation.
You may be asked to get up onto an examining table. Look to see whether the doctor observed you get on to the examining table. We frequently see reports from doctors that say the patient jumped up on the examining table without any difficulty or evidence of pain and therefore, the patient does not have a serious medical condition. If you have problems getting onto the examining table, you must ask for help getting on the table. Record this fact on the form your attorney will give you to complete after the exam.
The doctor may also ask you to do a range of motion test and will supposedly measure how well you can move every part of your body. For example: if you have a neck injury, you may be asked to turn your head to the right or to the left and/or to move your head down to your chest or move your head up to look at the ceiling. If you have any pain at all doing this activity, you must tell the doctor that it hurts to move your neck or head.
If you hurt your lower back, you may be asked to bend over to touch your toes, to stoop, to lift, or any other number of movements that would affect your back. Once again, if you have back pain during these movements, you must complain that it hurts to do these activities. Again, note this on the form that you will complete for your attorney after the exam. If you have nerve damage and this results in numbness to your hands, fingers, or feet, the doctor may stick needles in your hands or feet to see if you do not feel anything. The doctor may ask you to write something using a pen, type on a computer, or pick up a coin from the table. This is all done to see if you really do have nerve damage.
If you have pain that radiates, this may indicate serious damage to your spine. For example, if you have a neck injury, pain can radiate into an arm or hand and if you have a low back injury, pain can radiate into a leg or foot. Make sure you tell the doctor about any pain that radiates. If you have numbness in the hand, this may be due to nerve damage in the neck. If you have numbness in the foot, this may be due to nerve damage in the lower spine. Make sure you tell the doctor about any of these symptoms.
In a range of motion test, you may also be asked to move your arms, use your fingers, and use your hands for grasping, pinching, or reaching if these parts of your body have been injured. If you cannot grasp, pinch, or reach, you must not attempt to do more than what your limitations are when you are examined by the doctor. We see many reports from doctors’ exams saying the patient had no problems squeezing with the hand, no problems pinching, or picking up coins off a table or buttoning a shirt. Once again, the purpose of the exam is to document your injuries, not to show you can do more than what you usually do on a regular basis.
Similar issues arise if there are injuries or medical disabilities related to the hips. Any attempt by the doctor to get you to do more than what you can normally do should be objected to and you should complain about the pain the doctor is causing you.
We were also informed by a client that he was told to take the MMPI test home and to ask family members what the answers were if he could not answer a question. No test should be taken home since it cannot be verified who gave the answers to the questions. The MMPI is a test of 567 true/false questions. If you cannot answer 30 or more questions on this true/false test, the test results are not valid. If you do not speak English well, the test must be given in your native language. Never take the same test twice as this will result in higher grades the second time.
Psychological tests frequently are designed to determine how your daily activities, social functioning, concentration, and memory are changed by your medical conditions. If you are not impaired in these areas, you most likely are not disabled. Therefore, if you stay home and don’t socialize, you need to say so. If you cannot do household activities because you are too depressed, if you are unable to concentrate on reading a newspaper or watching TV because you are bothered by your own depression, or even if your pain interferes with concentration, let the doctor know how many minutes you are able to concentrate on these activities. Finally, they want to know if you are capable of persisting on any tasks without being bothered by your own impairments. If you cannot complete simple tasks, follow simple instructions, or remember simple instructions, be sure you tell the doctor. For example: are you unable to remember directions if you are lost on the street or are you unable to remember a telephone number from a caller if you do not have a pencil? If 5 minutes later you have a pencil to write the phone number down and you still cannot remember the number, then you would have serious memory problems.
The doctor may ask you to spell ‘world’ backwards or may give you 7 numbers and ask you to subtract the number 3 from each number. If you can do this, you may not be disabled since this will show that you can concentrate quite well and you are not bothered by pain or depression.
Just remember: the point of the exam is to determine the extent of your disability. Remember to talk about where you experience pain and how that pain prevents you from doing things like sitting, lifting, standing, walking, concentrating, and remembering things. For example: anyone who cannot lift a gallon of milk (which weighs 8 pounds), sit for more than 30 minutes without severe pain, stand for more than 30 minutes without severe pain, concentrate and/or remember what was on TV after l0 minutes, is clearly disabled and/or seriously injured. Do not exaggerate, but also do not forget to mention your real pain and functional limitations.
Thank you for allowing us to help you prepare for your medical exam.