The many facets of physician personalities are something that LNCs attending DME exams will experience. Some physicians are easier to work with than others.
This post will point out a variety of physician personalities and examples of dealing with them.
Physician Personality: Compassionate
Any LNC or patient will love having a compassionate physician. The compassionate doctors are easy to observe.
They do not pose any problems or manipulate the dynamics of what is supposed to happen during the exam.
Compassionate physicians know their duties as defense medical examiners and usually follow the rules.
Focusing on the client’s behavior, the compassionate physician notes if the client is in pain. They will not push the limits of the exam because they know if they go too far, they may cause the client some pain.
Typically, a state’s rules spell out that the DME is not supposed to be painful. However, some physicians cause pain, as described below.
Physician Personality: Friendly
A friendly doctor is the kind of doctor who is kind to the client, starts small talk, and tries to lower the client’s guard.
This doctor has an agenda to lull the client into revealing details they should not.
In response to the doctor’s friendly approach, the client may start sharing information they shouldn’t be discussing.
In the conversation, the physician may ask questions they shouldn’t. The patient may disclose information to a friendly doctor they shouldn’t. For example, the personal medical history, the work history, or any surgeries or injuries that do not have to do with the exam.
The goal is to make the client feel so comfortable that they won’t realize when the doctor asks questions they are not supposed to.
LNC Response
This pattern requires the LNC to be vigilant and stop the doctors from asking those questions (in states where that is permitted.)
The LNC must pay attention and notice when the doctor shifts from socializing to actual questions they are not supposed to ask.
Preparing the client before the exam to respond to these questions can prevent the client from falling into the traps laid by the friendly doctor.
Physician Personality: Sneaky
The sneaky doctor is closely related to the friendly doctor.
A sneaky doctor is usually jovial and makes the client feel comfortable.
When they come into the exam room, they have a list from the defense attorney that the defense wants them to look for. A non-sneaky doctor doesn’t come in with a list. They’ve already looked at the medical records before they arrived.
Here’s how the sneaky doctor’s behavior may manifest.
For example, if the client has more than one injury and has filed lawsuits for more than one, the doctor tries to confuse the client.
The doctor will say things like, “Oh, I have here your injury occurred on the 13th of July, 2014. You had a back injury?”
The client says, “Yes.”
“Did you fully recover from that injury?”
“Yes, I did before today (2024)”, which is, by the way, ten years later. “I have recovered from it and didn’t have any problem until this new injury happened.”
The doctor goes back and forth from that 2014 injury and says, “Are you sure you recovered? Because I don’t think you recovered.”
The doctor is not supposed to give an opinion. The only thing a doctor should be looking at to indicate whether the client has recovered is the results of the tests, x-rays, CTs, or MRIs. The doctor should be formulating opinions from that data, not because they think the client hasn’t recovered.
In response to the challenge, the client may argue: “Yes, I’ve recovered. Nothing happened after that until 2023 when I was injured.”
Then the doctor looks at another question on the piece of paper and queries the client: “I have some other information here that indicates that you had some other injury in a domestic violence situation.”
LNC Response
This is the opportunity for the LNC observer to redirect the doctor. “Doctor, we’re not here for any domestic violence situation. We’re here for an accident. Can we, please, concentrate on the accident in question?”
Another signal of the sneaky doctor is to make insinuations. Especially if the client has had a lot of injuries, the doctor passes comments like, “It looks like you’re injury prone. Every time you turn around, something is happening.”
The doctor makes the client uncomfortable with such comments.
For example, an 85-year-old woman was hit by a car when she was crossing the street within the crosswalk. The driver told the defense attorney that the woman was walking too slowly on the crosswalk. It was her fault because she was old and was crossing the crosswalk too slowly.
In this situation, the DME doctor said to her, “I see here you have diabetes, heart disease, and previous injuries. You’re just somebody laden with injuries. I can’t blame my client. You can’t make him responsible for whatever happened to you.” Note that suddenly, the defendant driver became his client.
I waited for the doctor to finish and then said, “Doctor, I understand where you’re coming from. But the only thing I have to tell you is maybe next time your client” because that’s what he called the defendant) “decides to hit somebody, maybe he should hit somebody healthy and not somebody old. Maybe somebody younger. It was just his bad luck that he hit somebody who was as old as this lady. Now he’ll have to take care of the lady’s problems due to the injury.”
The doctor looked at me like he was ready to kill me.
Physician Personality: Aggressive
An aggressive doctor does not care what the situation is with the client.
Most of these doctors already believe the client is putting on a show. If the documentation shows that the client has a valid reason for the lawsuit, the aggressive doctor still acts like the client is doing something wrong.
The LNC will spot this approach by noting how the doctor starts the exam by saying, “During this exam, I’m here to ask you questions regarding what happened. You need to know that you’re not supposed to lie. If you lie in this examination, I will report that information to the defense, the people who hired me.” From the start of the exam, the physician is aggressive and tries to intimidate the client.
Also, aggressive doctors are the ones who, during the physical exam, force the client to do a lot of the tests without giving the client any time to rest.
The doctor will tell the client, quite rudely, that they need to do the test where they lean forward, and they lean backward, and sideways. As the client is doing that and hasn’t even finished the test, the doctor immediately tells them to do something else with their neck or legs without waiting or giving them time to finish the first test. They’re telling them to do another test. They repeat this behavior until the client gets highly nervous.
LNC Response
When the LNC observes this pattern, they may comment, “Doctor, you’ve got to give the client time to do the test you’re telling them to do.”
“Oh, they’re supposed to do it,” he says. “They can do it as fast as I want them to, so they need to do it.”
In another example, an aggressive doctor started asking questions he was not supposed to. I blocked him from asking those questions.
The doctor yelled at the client and me, saying, “You idiots, you think you’re here to get money. We’re not going to give you any money. Get the hell out of my office. You’re not here for an exam. You think you’re here to control the exam.” And he kicked us out of the office and didn’t finish the exam.
Physician Personality: Intimidating
The aggressive and intimidating doctors adopt the same behavior pattern by advising the client not to lie.
“Look, you’re supposed to do what I tell you. If you lie, that goes back to the courts.”
The intimidating doctor doesn’t indicate they have medical records. They concentrate on intimidating the client.
The exam’s history part allows the intimidating doctor to ask questions regarding injuries. After the client identifies their injuries, the doctor is intimidating by asking the client, “Are you sure that’s what happened? Because there might be a possibility that’s not what happened.” The client looks at the doctor, puzzled.
LNC Response
In a state where the LNC is permitted to object, the LNC may say, “Doctor, you can’t do that. You can’t intimidate my client. You should directly ask your questions. If you are asking the questions you’re supposed to ask, we will let those questions go through. But you are not here to determine whether this client is lying or whether this client is putting on a show. All you’re here for is to do the exam, provide a report on doing the exam, and let whatever medical records, deposition, and other information you have decide on what the client is doing and is not doing. You’re not here to determine who is lying or telling the truth.”
Conclusion
Your job is to observe and document the exam. Some physicians will exceed what their role is without concern for the patient.
This post is only the tip of the iceberg regarding defense medical exams/records. In this blog series, I will share more information about the DME process when working with physician personality types.
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Pat Iyer is president of The Pat Iyer Group, which develops resources to assist LNCs in obtaining more clients, making more money, and achieving their business goals and dreams.
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