Through the Examiner’s Eyes: Distinguishing Objective from Subjective in IMEs

Understanding Objective vs. Subjective Findings in IMEs 

It’s critical that IME physicians rely on objective medical evidence rather than personal opinion in reaching their conclusions in an IME report. This means they also need to stay up to date on all aspects of medical treatment, including treatment norms in the workers’ comp industry.

When an IME is conducted, it must be based on observable phenomena, factors that the IME physician can see, measure, and describe, and it is best if these factors cannot be distorted by emotion or personal perspective from either the examinee or the examiner. 

Many factors that IME physicians assess rely on examinee feedback. For example, physicians may ask, “Do you feel this?” “Does this hurt?” These questions rely on examinee input, so the information is inherently subjective by nature. To be truly objective, findings must be independent of an examinee’s perceptions. Therefore, the IME physician will try to find ways to validate that information. 

If IME physicians perform tests that assess an individual’s range of motion, they will use measuring devices, such as a goniometer or an inclinometer. They may ask the individual to move a certain way and take a measurement of that movement. But this is still dependent on how far the examinee is willing to move or bend. The examinee may say, “That’s as far as I can go.” 

As discussed earlier, due to illness, behavior, fear, or psychosocial issues, examinees may impose limitations on themselves, so they don’t accurately reflect the true range of motion. 

Suppose an IME physician is observing an individual’s walking gait. This can be influenced by symptom exaggeration or what the person aims to communicate. For example, examinees might feel compelled to demonstrate the extent of their pain. To do this, they might amplify their pain responses. 

In summary, IME physicians will attempt to use objective medical information, and when they must rely on subjective input, they will try to find at least one way to validate it. 

IME Findings Include Various Types of Input and Assessment 

Factors that rely on an examinee’s input include: 

• Pain 
• Range of motion 
• Muscle strength and sensation 
• Validity of effort or symptom exaggeration

Factors that rely on the IME physician’s assessment include: 

• Palpation
• Measurements of range of motion or muscle mass
• Psychosocial issues 
• Validity of effort or symptom exaggeration

Clinical assessments that are more objective in nature include: 

• A blood test provides straightforward and objective results. 
• Imaging and X-rays may require some interpretation, but for the most part, if it’s a fracture or dislocation, it’s straightforward to confirm and is considered objective medical information.
• Deep tendon reflexes are difficult for examinees to adjust or modify, so they’re relatively objective factors.

In our next OnPoint post: When the Signs Don’t Match the Story: Identifying Medical Inconsistencies. 

If you are ready to explore further, download the entire IME eBook here: Emperion eBook. 

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