Steps to Spotting Patients Who Are Faking
Review physicians get special training in detecting fakers. For instance, they learn the "mechanism of injury," which involves understanding how injuries take place, Pushkin says.
"It's unlikely that patients who have a slip and fall would injure their knee, because in most cases you fall backward," he says. "In a trip and fall, on the other hand, you fall forward. But these are not things you are taught in medical school."
Physicians also have to listen well to patients' backstories. "It may be that the real reason for a disability request has nothing to do with an injury," Pushkin says. "For example, the company moved the employee to a different shift, and they're not properly trained to do that work, so they are looking for a way out."
The work also requires hard skills, such as how to carry out a disability exam and fill out a residual functional capacity (RFC) form, which Social Security needs. The RFC form requires doctors or their designees to undertake a variety of measurements, such as lifting a certain amount of weight.
Assigning exact values for a disability can be challenging, says Mokotoff, the Florida cardiologist. For example, the doctor has to assign a percentage of disability to the patient, such as 5% disabled.
"Percent disabled can be defined to some extent in cardiology because we have some objective tests, such as the treadmill," Mokotoff says. "But it's much harder to do for neurologic diseases, such as fibromyalgia and chronic fatigue syndrome. It's hard to objectively measure these conditions."
A variety of groups offer short courses on this work. Pushkin says the American Academy of Orthopedic Surgeons offers courses that last 2.5-3.5 days, which he will start teaching this fall.
In addition, the International Academy of Independent Medical Evaluators, which represents reviewers, offers courses with similar lengths. And Dorto teaches courses for SEAK, which offers continuing education on a variety of nonclinical topics for physicians, including disability review.
However, Pushkin says these courses attract very few full-time treating physicians. Attendees tend to be physicians who want to be reviewers—particularly older physicians who aim to supplement their income with nonclinical work, he says. In his experience, 80%-90% of attendees in the room are older doctors.
Why don't mid-career physicians attend? "The average orthopedic surgeon wants to use continuing medical education to learn a new clinical skill," he says, speaking for his own specialty. "This kind of skill sounds very boring."
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Cite this: Leigh Page. How Some Patients Fake Illness or Injury and Get Away With It - Medscape - May 14, 2019.