AMA Ethical Guidelines on IME Assessments

INDEPENDENT MEDICAL ASSESSMENTS

Ethical Guidelines – AMA

The Australian medical Association published the following on their website:

https://ama.com.au/ausmed/independent-medical-assessments

[sic]

A major source of confusion for, and complaints from, patients relates to independent medical assessments, particularly regarding the role of the doctor and the nature of the relationship between the doctor and the person being assessed (the examinee).

When conducting an independent medical assessment, a therapeutic relationship does not exist. The doctor’s role is to provide an impartial medical opinion to a third party (such as an insurer), not to treat the person or to advocate on their behalf. The assessment results in a report to the third party and not to the examinee or their treating doctor.

Most people attend a doctor for therapeutic purposes, where the doctor’s role is to care for you, to protect the confidentiality of your personal information, and to advocate on your behalf if required. In a therapeutic relationship, the doctor’s primary duty is to the individual patient.

When serving as a medical assessor, the doctor’s primary duty is to the third party. It is this dichotomy between the doctor-patient relationship and the assessor-examinee relationship that lends itself to confusion. To make matters worse, many people who present for an independent medical assessment will already be nervous or anxious because compensation, insurance cover and even employment, may depend on the outcome. Confusion over the nature of the assessment may only add to the anxiety.

Because examinees must consent to participate in an assessment, and for a report to be provided to the requesting party, it is essential to ensure that they fully understand the role of the doctor and the nature of the assessment. Effective communication is key.

To assist members in discussing assessments with examinees, the AMA has updated the Ethical Guidelines on Independent Medical Assessments 2010. Revised 2015, which provide guidance on:

  • the role of the doctor and the nature and purpose of an independent medical assessment;
  • obtaining consent from the examinee;
  • using chaperones, support persons and interpreters;
  • what to do if the examinee refuses or withdraws consent;
  • use of audio or video recordings;
  • managing incidental clinical findings;
  • preparing the report; and
  • attending court and giving evidence in relation to the assessment.

The Guidelines have been updated with advice from several medical defence organisations, and are can be downloaded from the AMA website – along with a range of other AMA medico-legal guidelines addressing sickness certificates, disclosing medical records to third parties, maintaining professional boundaries, acting as an expert witness and conducting patient examinations.

The AMA Ethical Guidelines on Independent Medical Assessments 2010. Revised 2015 supersede the AMA Ethical Guidelines for Conducting Independent Medical Assessments 2010 and AMA Guidelines for Report Preparation and Court Attendance in Relation to Independent Medical Assessments 2010.

These and other guidelines are not just for members, and can be used to help inform patients and their families, as well as third parties such as employers, about the ethical and legal obligations of doctors in a range of medico-legal focussed issues.

All guidelines are publicly accessible on the AMA’s website at https://ama.com.au/advocacy/ethics-professionalism (under Reports, Guides and Publications).

Ethical Guidelines on Independent Medical Assessments 2010. Revised 2015

 

AMA Ethical Guidlines for Doctors acting as Medical Witnesses 2011. Revised 2016