Speaker: The examination starts as soon as the examinee is observed entering the office. Is the examinee moving normally or slowly? Is there a limp? Is the examinee using any assistive devices such as cervical collar, sling, back brace, cane, or holding onto the arm of a helper?

Dr. Brigham: Good morning, Steve. I’m Dr. Brigham, why don’t you have a seat right here.

Speaker: If secondary to underlying physical pathology, slow walking and limping will be consistently observed over time. Deception may be suspected if walking speed normalizes or the limp disappears when the examinee believes that they are no longer being observed.

Some examiners have their receptionist write down his or her observations of the examinee. The receptionist could answer the following questions on a form, which will be given to the examiner. Does the examinee limp to and from the desk? What is the examinee’s sitting posture? Does the examinee use any assistive devices such as a cane or crutches? Does the examinee exhibit any pain behavior such as grimacing?

Some examiners observe the examinee when he pulls into the parking lot, gets out of his vehicle, and walks into the office building. They will also observe the examinee during the interview and will note any inconsistencies between the claimed physical limitations and the physical abilities demonstrated. If, for example, an examinee stated he cannot sit up for more than 20 minutes but drove himself 45 minutes to the exam, there would be an inconsistency.

Examiners will sometimes observe the examinee disrobing or donning clothes immediately before and after the actual physical exam. The examiner will note if the function demonstrated is consistent with the physical abilities or disabilities reported. They may also observe the examinee on leaving the office. An examinee who claims to have disabling back pain yet easily slips into a two-door vehicle upon leaving the IME may be deceptive.