Independent Medical Examinations

My attorney scheduled me for an "independent medical examination" at the request of the evil opposing counsel.  At the time I had no idea what an IME was, but I was petrified.  The recent experience of jumping from doctor to doctor hearing perfume doesn't make people sick or perhaps psychological counseling would help? made the thought of visiting a doctor specifically chosen to destroy my credibility just a little unnerving.  My attorney offered little support other than informing me it was their right and by law, if I wanted to play the legal game, I had to comply.

On top of the idea of impending humiliation, it was an appointment with an allergy doctor. Having had numerous allergy doctors refuse to see me because MCS wasn't an "allergy," I wondered about the opposing counsel's game plan. What was their agenda? I was haunted by the fact that this doctor's name sounded vaguely familiar.  Had I read about his opposition to MCS somewhere? Is he the evil one? Am I being sacrificed for the sake of legal clarity?

I asked my environmental medicine specialist if he knew this doctor.  He told me he did, very well, and had some rather passionate discussions with him on the existence of MCS.  I was informed that this man would not, in any way, help my case, but more likely damage it as he believed MCS is all in our heads.  More panic.  I asked my attorney if I could refuse or somehow request another doctor since this one was already biased.  Nope, they get to choose who they want.  This is part of the game. Great.

The following is a list of suggestions, tips and advice on how to survive the IME game.  It's based on my experience with a touch of panic-based research, confidential disclosures from my attorney, and a lot of reflective opinion.

1)  An independent medical examination (IME) is a standard, common procedure in legal medical cases.

2)  Legal representatives or insurance companies have the right to request an IME for  legal proceedings.  Those that request will pay the costs.

3)  The party requesting an IME will choose a doctor who is knowledgeable, yet biased toward their own agenda, therefore, an independent medical examination is anything BUT independent. This is normal, expected and understood by all parties as part of the legal process. Requesting another doctor is permissible, however, highly discouraged and only if there is a very good reason.

3)  Request the "scope and sequence" of the IM examination from your lawyer.  This is your right.  It will give you a very vague idea of what will happen, but at least an idea. Knowledge is power.

4)  Make it clear to your lawyer the doctor's office must be fragrance-free.  In addition, if your health is compromised by auto exhaust or other environmental factors regarding the commute, request to choose the time and day of the appointment.

5)  Let your lawyer know you will not subject yourself to tests that will compromise your health, i.e., allergy tests, inhaler tests, any procedure using chemicals that may produce symptoms.

6)  Do not take any documents or notes to the doctor's appointment unless your lawyer instructs you differently. If you do, the doctor may ask to see them and make note of them in his written assessment. This may end up as evidence. You may take blank paper and pen to take notes if you desire. Be prepared to eat them.

7)  Avoid taking friends or relatives with you. The doctor will ask your friend's name and write it down as part of the examination.  Subsequently, the opposing counsel may subpoena him/her as a witness and require disclosure of conversations before and after the appointment regarding the appointment.  If possible, take your attorney's secretary, legal assistant or paralegal and ask him/her to take notes for you. (I believe they will be documented, but are bound by attorney-client confidentiality?  Don't quote me.)  However, don't make the mistake of feeling secure with this support. Although your lawyer's legal assistant may be instructed by your lawyer to support you should you refuse a procedure that you feel may compromise your health, he/she will usually not converse with the doctor.  And, this is not T.V. law - don't expect them to jump up and "oppose" questioning in a legal capacity. The legal assistant is only there as a supportive witness. Reminder: Don't let your guard down and feel too safe with their presence.  If a legal assistant is not provided, take a spouse who cannot be required to testify, or a very, very close friend, but inform him/her of the consequences and subsequent involvement (they may be deposed at a later date...). Again, if this support distracts you from concentration, go alone.

8)  Arrive at the doctor's office on time.  If you should arrive early, do not discuss your situation or case in the lobby or in the office as you wait. Assume there are spies. Assume the lights have cameras and the plants are bugged. As I waited to be called for my IME, there was a woman sitting in the lobby dressed in a tennis outfit pretending to read a magazine. My appointment was about an hour late and she was waiting the whole time. Odd. I kept my eye on her. No one else was in the lobby. The legal assistant and I talked about her children and allergies. When I was called in for the appointment just as I was walking in, out of the blue she said to me from behind, "You know it isn't that bad." Surprised she was acting like she knew me or she had any business listening to our conversation I replied, "How would you know? You don't even know me." Even though I had no idea what she was talking about.

9)  Expect to be asked every little detail about your health history and your family's health history.  These questions will reappear two or three times throughout the appointment formatted differently each time. Know your history and the scope of your medical records involving your case. It is highly advised to be honest, however, remember you are not under oath and are not obligated to disclose all.  The doctor doesn't need to know your great aunt's history of gout. Also, don't refuse to answer questions or it will be documented and your honesty will be, therefore, suspect. Be pleasant, kind, and appear forthcoming, honest and eager to please at all times. If you choose not to answer a question, a puzzled look and, "I don't remember" will usually suffice. Resist the temptation to say, "It's none of your damn business" or "What does that have to do with anything?"

10)  If you don't understand the question or the terminology used, ask for clarification. This can get tricky depending on their agenda. For instance I was asked "Do you have panic attacks?"  Now I could have said, "Well, yeah, I had one when I heard about you."  Unfortunately, I didn't know what a "panic attack" was so I chose to answer as clearly as possible: "When perfumes and chemicals stop me from breathing, I sometimes feel panicky."  He continued to repeat, "But do you have panic attacks?"  I should have asked for a definition and my look of bewilderment went ignored, but I didn't so I couldn't decisively say "NO, I don't have panic attacks".  It was as if he waited, amused, for me to hang myself with my words. It went down on my evaluation that I suffer from panic attacks, although now having researched the definition I know I've never had a panic attack in my life.

11)  Qualify your specific MCS symptoms with "...if exposed to [perfume]."  For instance, "Do you get headaches?"  If you only get headaches when you are exposed to perfume, say so or it will be noted "suffers from headaches" regardless of the cause.  "I get headaches when I'm exposed to perfume." "My ears often hurt...when I'm exposed to perfume." "My joints hurt...when I'm exposed to perfume." Don't assume the doctor is making the assumption that your symptoms are caused by chemicals because he/she won't.  The doctor is finding ways to discredit your legal testimony. This is the IME doctor's job.

12)  Expect the doctor to disagree with you.  From what I understand they are supposed to appear unbiased, but arrogance often supersedes.  If he/she says with a chuckle, "Perfume doesn't produce asthmatic symptoms, that's ridiculous." Don't scream and lunge for his/her throat, just smile calmly and wait for the questioning to resume.  Assume all your reactions and your comments will be noted for the record.

13)  When the interrogation part of the examination is finished, the physical examination begins.  Be attentive.  If the nurse comes at you with rubbing alcohol/Freon-based inhalers/allergy test injections and you know you will react, refuse.  The nurse may ask you why.  My repetitive response was, "I am chemically sensitive and that will compromise my health."  Don't allow them to make you feel intimidated with bewildered looks or I need to go discuss this with the doctor threats. Always assume they don't believe you have a problem and you have to protect yourself.

14)  When they release you, smile and leave.  If the receptionist asks if you would like to make another appointment, smile and say, "Not in my lifetime." Treat yourself to something special so your blood pressure will go back to normal.  The end.  You survived.

The real assessment of survival is the doctor's written evaluation which will be mailed to the opposing counsel with a copy to your lawyer and a copy to you from your lawyer, if requested. The document may be swayed with subliminal vocabulary such as she THOUGHT she was sick, she PERCEIVED..., she ALLEGES... and/or will include blatantly incorrect details formulated by the doctor's assumptions, but it's the legal ramifications of his findings that are the most valuable.

I was somewhat fortunate as this allergy doctor found me to be in need of psychotherapy and my psychosis was "reinforced by her unorthodox health perspectives as well as by unorthodox health practitioners".  He concluded, "These individuals, once they come to believe that they are being harmed, are very difficult to treat.  Early on, sometimes psychotherapy is beneficial, but once the belief becomes ingrained, it is hard to dissuade them."  It's still hard for me to believe that educated physicians in this day and age are still so narrow-minded. And, how is an allergy doctor a legal expert in psychiatry?

The written assessment wasn't as bad as I expected.  He actually acknowledged because of my psychotic belief that perfumes were harming my health, I would benefit from a fragrance-free environment. Also, my lawsuit was focused on disability and lack of accommodation and this IME only supported the fact that I was still disabled (although psychologically rather than physically) and I should have been accommodated regardless. He also said I was pleasant. Ah ha! His assessment of me might not have been so glowing if I had grabbed him by the throat  when he started whining about the inconvenience of his Jaguar being in the shop at the same time he was vacationing in Prague. There are advantages to being non-violent.

For the MCS patient who has experience with useless, conventional doctors, facing yet another skeptic can be quite unnerving especially one hired to discredit your very existence. Unfortunately, IMEs are part of the legal hoop jumping process. Think of it as an elaborate game and winning the game means more support and recognition for multiple chemical sensitivity.