Quest for objective assessment of impairment

Impairment evaluation using the American Medical Association (AMA) Guides is an important requirement in the medico-legal arena, but correct application can be a daunting process given the Guides’ complexity. This casebook highlights the need for a good understanding of how to apply the Guides correctly and for a thorough objective assessment. For clinicians involved in impairment assessment, this book provides an insight into the methods of evaluation as well as some of the shortcomings of these methods.

Sixty-eight cases are presented, most of them relating to musculoskeletal disorders. There is a broad spread of clinical cases; ranging from the more severe and catastrophic injuries, to more common conditions. The more controversial and ill-defined conditions, such as complex regional pain syndrome, fibromyalgia and the curiously termed "elusive cumulative trauma disorder", are discussed in detail.

Each case is presented with a history and physical examination followed by a discussion of the rating according to the 4th and 5th edition of the Guides. After each case, there is a useful explanation of the differences between the ratings as well as relevant discussion on the difficulties of evaluating impairment. In most cases, there is little difference between the rating according to the 4th and 5th editions, one exception being impairment of the spine. The other differences are mostly with regard to musculoskeletal disorders.

Given the current preponderance of claims for loss of sexual function following spinal injury, and cognitive loss following relatively mild traumatic head injury, the detailed discussion of these cases is particularly relevant. Problems associated with impairment evaluation in the presence of pain behaviour and in patients with poor credibility are also discussed.

This book is topical, user friendly and essential for clinicians who carry out independent impairment evaluations. Although many insurance companies require clinicians to complete a certified course before undertaking evaluations, this casebook illustrates that being certified in the use of the Guides is not sufficient. Thorough and objective clinical examination remains a necessity for impairment evaluation, particularly in musculoskeletal injury.

My experience in reading medico-legal reports is that while ratings according to the AMA Guides are frequently quoted, the clinical findings of the examiner often do not stand up to close scrutiny, and incorrect impairment ratings are sometimes provided. Hopefully, this casebook will assist both doctors and lawyers in their quest to provide objective and accurate evaluation of impairment. The book is value for money and essential reading for those who are called upon to provide an assessment of impairment.

Seamus E DaltonOrthopaedic Surgeon Crows Nest, NSW

Order this book

See also:• Guides to the evaluation of permanent impairment (5th edition) • Special package prices