Dr. Zünkeler performs medical evaluations as requested by insurance companies, government organizations, and legal professionals. In Maryland, this type of evaluation is most commonly referred to as an “independent medical examination” (IME), but other terms include “compulsory medical examination” (CME) and “additional medical evaluation” (AME). An IME ideally combines a careful review of the available medical records and diagnostic imaging studies with a physical examination and the examinee’s in-depth verbal history. IMEs are considered to be non-treatment encounters, so a traditional patient-physician relationship does not exist. The term “examinee” instead of “patient” is usually used to avoid confusion. In select few cases, when a physical examination is not essential, Dr. Zünkeler also offers telemedicine IMEsfor examinees who were previously seen in the office for an in-person IME and are physically located in Maryland at the time of the telemedicine IME.
Opinions regarding diagnoses and treatment options are usually not discussed with the examinee during an IME. Examinees are encouraged to continue seeing their treating health-care providers as needed. An IME report documents the verbal history and physical examination of the examinee, discusses the records and diagnostic images reviewed, and provides a list of diagnoses. In addition, a “Discussion” section provides a synopsis of the case and discusses important objective findings and diagnoses. Finally, the specific questions of the IME requester are answered. The completed report is proofread for accuracy, signed, and returned to the IME requester usually within 3-5 business days after the IME .
An IME report provides a careful review of available medical records and diagnostic imaging studies and a detailed verbal history and physical examination. Based on this documentation, an experienced independent neurosurgical examiner is able to formulate opinions regarding an examinee’s diagnosis, prognosis, and treatment options and whether an end point of treatment (i.e. maximum medical improvement (MMI)) has been reached. In addition, the degree of probability to which a certain incident (e.g. a work injury, car accident, heavy lifting, or fall) caused a certain pathology (e.g. a disc herniation) and whether a treatment intervention (e.g. microdiscectomy surgery) is causally related to the reported incident can usually be addressed. IME reports commonly address some or all of the following:
diagnosis and prognosis,
causal relationship of reported symptoms and physical exam findings to the incident or injury,
appropriateness of medical or surgical care,
pre-existing or subsequent medical conditions and the degree to which they contribute to the examinee’s findings and symptoms,
degree of relatedness of medical or surgical care to the incident or injury,
causal relationship (or lack thereof) of symptoms and findings to an incident or injury,
return to work,
endpoint of treatment (i.e. MMI), and
ratings of permanent impairment according to the American Medical Association’s Guides to the Evaluation of Permanent Impairment.
Additional records or diagnostic imaging studies provided after the IME are discussed in an addendum report or at the time of a follow-up IME appointment.
An IME can be a valuable tool in assessing an examinee’s health condition and neurosurgical status, including cognitive, spinal, and musculoskeletal functioning. The quality of an IME report depends on certain factors, some of which are outside the control of the independent neurosurgical examiner, including (i) the completeness of the medical records provided (which should include pre-incident records and diagnostic imaging studies on CD, if available) and (ii) the degree to which the examinee is willing to cooperate with the evaluation by:
arriving on time (15 min early, if possible) to complete the standard office forms, which may include brain injury questionnaires (only after a concussion/brain injury);
bringing relevant diagnostic imaging studies on CD; and
providing a good verbal history.
An IME may not be conducted or may be of reduced quality if:
the examinee arrives more than 15 minute late,
the examinee does not bring diagnostic imaging studies on CD,
the medical records are incomplete, and
an interpreter is not provided when needed.
If an examinee is more than 15 minutes late or if an interpreter is needed but not available, the IME will need to be rescheduled.
Atelemedicine IMEposes several additional challenges and limitations and, like a traditional IME, depends significantly on the examinee’s willingness to cooperate. A physical examination, other than an observation, cannot be conducted during a telemedicine IME and the examiner’s ability to observe the examinee can be adversely affected by several technical factors, including poor lighting, camera position, and slow internet connection. Because of the limitation of a telemedicine encounter, the diagnostic accuracy is not as good as that of an in-person encounter, particularly to the extent that physical examination findings contribute to the diagnosis.