Excerpted from SEAK’s stream on-demand course, “How to Start, Build, and Run a Successful IME Practice”
Steven: For emergency situations like a cancer that you notice, there’s no physician-patient relationship. However, you can create a physician-patient relationship. Of course, if you can create a physician-patient relationship, now you’re liable for medical malpractice, okay? So you don’t want to do that. One of the benefits of being an IME doctor is that you don’t have a physician-patient relationship, and generally speaking, you won’t have any liability for medical malpractice so how do you create a physician-patient relationship and make yourself liable?
Number one, in your report, you keep referring to the person as a patient. So, people…and it’s funny because a lot of doctors have a standard language in the beginning of the report which they copy out of some of the books that I inform the person there is no physician-patient relationship. Next sentence, the patient told me this. And then throughout the report, the word patient is used 45 times, okay? You tell them no physician relationship, so don’t use the word patient. Use the word Mr., Mrs., claimant, examinee, or whatever, not the word patient. Okay.
The second thing is giving them medical advice, even the smallest medical advice. So as the person is walking out of his room, he goes, “Oh, doc, can I go play golf, can I play golf?” You say, “Sure.” Okay, what happens? He’s on the first tee, he has a Tiger Woods moment. He reaches back, you hear like…he takes a big swing, you hear like… okay? Next thing you know, he’s on the ground crying. And, you know, after taking him away in the ambulance, they say, “What happened?” He says, “I went to that IME doc, he told me I could play golf, and now I need a fusion.” Gee, who’s responsible? Answer is the doctor that told me to play golf may be liable, okay?
And people will ask you all kinds of medical questions. The reason generally is because you’re actually interested in what they say, and you have time to talk to them. You don’t have 36 patients that day on your call list. Really? Okay. You don’t have 36 patients on your call list you have to see every 15 minutes, and you might spend an hour, hour-and-a-half, depending on how complicated the case is. And a lot of times people will say, “You know, this doctor spent more time with me than my treating doctor. I liked him, I liked her.” And, of course, they could say, “Well, you know, could I go back jogging now? I mean I feel good.” You know, don’t give them any medical advice. Always tell them, “Talk to your treating physician about this.”
Dr. Dorto: Yeah. Let me just add that although there is no treating doctor-patient relationship established, according to the American Medical Association, whenever you put your hands on anybody’s body, there is an implied doctor-patient relationship established for the purposes of liability. Now, what does that mean? I’ll give you an example. Let’s say someone has had a rotator cuff repair, okay, and you say, “Well, how much can you lift up your shoulder like this, go like that? Is that all you can do? Let’s see, maybe, you can do more,” and you disrupt the surgery. They could come back to you for the purposes of liability and sue you for malpractice for that. So keep in mind. So what do I do in my reports? I usually say in the first or second paragraph, “Mr. Brown understands that there is no traditional treating doctor-patient relationship established.” That’s how I put in my report.
But you have to be aware that if you see something that could be damaging to their health, you’re obligated to tell them and put it in your report. Let me give you an example. I always check the blood pressure on everyone, everyone. And a couple times a year, I’ll pick up someone that has uncontrolled hypertension for whatever reason. I document it, I’ll repeat the blood pressure. If it’s still high, I write it down, and I give it to them, and I dictate in the report, “One of the impressions is uncontrolled hypertension. Mr. Brown was advised to follow up with his treating doctor.” You’re obligated to do that. I’ve also picked up skin cancers on the face, I put that in my report. Once I picked up what I thought was an abdominal aortic aneurysm, that went in the report. So if you find something that could be damaging to them, you’re obligated to tell them. And put it in the report.