Academy of Independent Medical Examiners, Hawaii
Aiming to Advance the Specialty and Quality of Independent Medical Examinations in Hawaii

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AIMEHI IS COMMITED TO THE ADVANCEMENT OF THE IME PROCESS. WE FEEL EDUCATION IS A PRIME WAY OF IMPROVING THE IME PROCESS. THEREFORE WE ARE PLEASED TO PRESENT THESE EDUCATIONAL PROGRAMS

MENU OF NEW EDUCATIONAL EVENTS:

NEW, Ongoing CME education series for IME Examiners and Professionals in the Industry.

MENU OF PAST EDUCATIONAL EVENTS :

Past Ongoing CME Meetings

ONE DAY WORKSHOP FOR CASE MANAGERS AND ADJUDICATORS

ABIME NATIONAL CERTIFICATION COURSE HELD ON BIG ISLAND FEBRUARY 23, 24 2002
The Big Island Course was jointly sponsored by AIMEHI (local) and ABIME(national)

ABIME NATIONAL ADVANCED IME REPORT WRITING WORKSHOP HELD IN HONLULU AUGUST 1,2003
This course was jointly sponsored by AIMEHI (local) and ABIME(national)

DLIR HEARING OFFICER TRAINING
AIMEHI assisted the DLIR (Hawaii Department of Labor and Industrial Relations) in training hearing officers on June 17, 2005. Although AIMEHI did not conduct the training, it assisted the DLIR obtaining quality instruction. AIMEHI suggested Dr. Chris Brigham put on the instructional seminar and he did a superb job as usual. Dr. Brigham, a Master Fellow of AIMEHI, also had 3 other AIMEHI Physicians (Dr. Nierenberg, Dr. Brewer and Dr. Direnfeld) on a panel to explain clinical aspects. Key points included that the ODG were to be used as guidelines and there use was explained.

 

CME education series for IME Examiners and Professionals in the Industry.

NEXT MEETING
July 11, 2008
Topic AMA 6th edition of Guides to the Evaluation of Permanent Impairment
Click here for pdf of course

 

 

LAST MEETING February 25, 2008
 Topic: AMA 6th edition of Guides to the Evaluation of Permanent Impairment
Dr. Brigham discussed the recently published 6th edition. This was overview of very large topic. It was agreed further education on this subject is necessary as there will be a challenge learning the "new paradigm"
 

FIRST MEETING
November 21, 2002 (A big success)
Topic: Report Writing
REVIEW: The program started out by Dr. Brigham giving an excellent presentation on
the IME report writing process but it quickly turned into far more than that
with excellent round table type discussions.
In addition to the objective areas of the report process, the attendees
shared valuable information about the psychological aspects of the IME process.

SECOND MEETING
Topic: Discussion: Iatrogenic Disability: A forum for discussing behavioral and psychological issues
January 16, 2003
Time: 6:00 - 8:00 pm
Location: American Cancer Society, 2370b Nuuanu Avenue
Audience: AIMEHI members, colleagues in psychology and psychiatry
The goal of this meeting is to provide through the topic of Iatrogenic disability an opportunity to discuss behavioral and psychological issues often encountered with independent medical evaluations.  The intent is to engage the participants in an active process resulting in a better understanding of needless disability caused by the health care system.

REVIEW: This was a great meeting with lots of spirited discussion. Representative comments from Participants, "I was very impressed with the level professional content" "Great meeting, I really enjoyed it."

An excellent handout (PDF) also courtesy of Dr. Brigham is available. 

THIRD MEETING

Topic: Terminology in Worker's Compensation IME Reporting
March 20,2003:
Location: Queen's Medical Center Harkness Dining Room Conference Room
Principal Presenter: Dr. Francis Brewer

REVIEW: Another Great meeting! We found out that Hawaii has very unique definitions of terms in Work Comp arena that do not match national definitions or those used in AMA Guides 5th edition. Guests included representatives from DOL and attorney expert in Work Comp Law.

FOURTH MEETING
Topic: Rating the Spine
 June 5, 2003
Location: Queen's Medical Center Harkness Dining Room Conference Room
Review: Many interesting aspects of spine rating discussed. Excellent discussion of Non surgical and Surgical Cases scenarios.

Click here for PDF handout of June 5 Spine meeting


FIFTH MEETING
September 25, 2003 6pm
Topic: The Neurologic Examination of the Patient with Low Back Pain
Location: Queen's Medical Center Harkness Dining Room Conference Room
Principal Presenter: Dr. Lorne Direnfeld MD

Click here for handout This is an excellent reference by Dr. Direnfield even if you don't attend the meeting

SIXTH MEETING
January 15, 2004
Topic: Spine Surgery and other Interventions
Location: Queen's Medical Center Harkness Dining Room Conference Room, 6pm
Principal Presenter: Dr. Jon Scarpino
Again a successful meeting. Key points were:
Discography is best used as tool to plan surgery not to diagnose problems. Proper modern Technique in discography is essential. To be positive, symptoms, other tests, image morphology and technique must all correlate. Discography per se can cause prolonged back pain. There is high correlation between discography and somatization therefore psychometric testing is highly recommended if discography is ordered. Discography is still a highly controversial area. Other topics reviewed included Facet joint injection, RF ablation and artificial discs .


SEVENTH Meeting
March 25, 2004
Topic: Standards for treatment using Passive Care
Location: Queen's Medical Center Harkness Dining Room Conference Room, 6pm
Principal Presenter: Dr. Francis Brewer
Review: This was a really fabulous review and discussion of Passive Care.
For those of you who missed it click here for PDF file of Dr. Brewer's Presentation.

MEETING # 8
May 20, 2004
Topic: Practice Pearls
Location: Queen's Medical Center Harkness Dining Room Conference Room
Time: 6:00 - 8:00 pm
Review: An informal meeting with lots of practical tips for IME's were shared by attendees.

MEETING #9
September 16, 2004
Topic: Legal Aspects of IME's from Defense Point of View( Plaintiff aspect will be following meeting )
Guest: Bev Tom
Location: Queen's Medical Center Harkness Dining Room Conference Room
Time: 6:00 - 8:00 pm
Bev Tom gave a great presentation on IME requirements from the defense standpoint. Here presentation related mostly to Worker’s Comp Cases
Some pearls were:
It is important to realize what stage the case is in. Initially often times the most important item is causation. When the case is in middle stage, questions revolve around treatment. At the end of the case Impairment is usually the most important issue. Once an impairment rating is requested and liability has been previously accepted, the IME physician challenging causation at that point never changes the liability acceptance of the case.
Ms. Tom noted there was a turnover in insurance industry adjustors with many of older more experienced adjusters being replaced by younger ones. This means that more explanation is often warranted in reports especially when explaining what the diagnosis means. It is very important to make a clear diagnosis.
She said it was important to a least mention each and every document and source of material reviewed. This is of particular importance in reviewing statements by others such as witnesses. A complex discussion on aggravation, recurrence and exacerbation was held. Unfortunately in Hawaii these terms are hard to come to grip with unlike the cut and dried National definitions.
MNG

MEETING #10

Topic: Legal Aspects of IME's from Plaintiff Point of View. Mr. David Robinson presenting.
November 18, 2004 6 pm
Location American Cancer Society. 2370 Nuuanu.
Mapquest link
REVIEW: The presentation focused mostly on the Worker's COMP arena. Mr. Robinson emphasized that IME reports carry tremendous weight in determining the injured worker's treatment and ultimate outcome of case. He discussed the problem of the biased examiner and gave some real examples of egregious reports. He encouraged Examiners to try to get full accurate and unbiased history. He also gave examples of how some unnamed examiners had gotten a reputation for bias. A vigorous round table discussion of issues comprised most of the second half of the meeting.

MEETING #11

April 21 ,2005
Topic: Technology Solutions: Improving quality, efficiency and profitability.
Presenter: Dr. Chris Brigham
Review:
An absolutely superb presentation with lots of real world pearls for use of computer technology in IME's. Topics ranged from the simple, like effective use of email, to more complex like advanced capabilities of Word. Reviews of everything from graphic imaging to advanced use of server technology was clearly explained by Dr. Brigham. His presentation focused on achieving excellence using the electronic process to make things more efficient. As an added bonus, he demonstrated in real time, a variety of electronic web search and reference tools. This was one of the best presentations so far and extremely practical with real world nuts and bolts techniques.

MEETING #12

August 18, 2005
Topic: Chronic Pain
Review:

Dr. Rodgers spoke on Chronic pain.
He made the distinction between chronic and acute and noted if you treat chronic like acute, you actually make it worse.He talked about predisposing risk factors to development of chronic pain, which sparked some fascinating and useful round table comments. Risk factors included previous trauma, childhood abuse, emotional disorders,personality disorders, anxiety, job dissatisfaction, previous litigation, and family history of parents. Non organic Reactive factors were also discussed. There was also a description of MMPI-2 testing and what it means. All in all, a fabulous meeting. Thanks to Dr Rodgers for speaking and to Dr. Brewer for organizing it.

MEETING # 13

November 17, 2005
Topic: Chronic Pain: Treatment with Medication
Presenter: Dr. Lorne Direnfeld
REVIEW: An absolutely superb presentation with a very delightful style. Covered most of the major topics.  Key concepts included Acute vs Chronic pain, definitions and the emotional aspect of suffering. There is controversy in the field regarding use of Opioids and this was well covered. This very useful presentation can be found in pdf format here.

 Meeting #14

April 6, 2006
Topic: National Standards for IME report writing
Presenter: Dr. Chet Nierenberg
REVIEW: The advantages of using  the National Standards for report writing were discussed. Using the Standards ensures quality, accuracy, uniformity and ease of readability. A lively question session generated much valued discussion. Many of the points raised had been previously discussed by the national committee that wrote the Standards. Dr. Nierenberg explained the committee's reasoning. A copy of the Standards can be found here.

Meeting #15

June 29, 2006
Topic: Nonorganic Signs in Physical Examinations
Presenter: Dr. Stephen Demeter
REVIEW: Dr. Demeter gave an excellent presentation on nonorganic findings. He cited two excellent papers on the subject.
"Nonorganic Findings" by Christopher Brigham MD in "The Guides Newsletter" July/August 2000.
"A Structured Evidence-Based Review on the Meaning of Nonorganic Physical Signs: Wadell Signs" Fisbain et all, American Academy of Pain Medicine Vol. 4, num. 2, 2003.

Some interesting tidbits. Surprise, it was concluded that legitimate radiculopathy CAN produce Stocking anesthesia.

Wadell's signs do NOT
demonstrate test retest reliability
correlate with psychological distress
associate with secondary gain
discriminate between organic and nonorganic problems

Wadell's sign DO
associate with poor surgical outcome
associate with greater pain.

Overall many of the members were quite surprised by some of the findings. A lively round table discussion ensued with many Physical Examination Pearls. Dr. Direnfeld gave invaluable insight  from a neurological perspective. Dr. Slomoff gave very astute comments on the psychiatric aspects. It is recommended that you read the Fishbain article to draw your own conclusions.
 

Meeting (#16) March 8, 2007
 Topic: Followup On Wadell's signs and non organic findings
 Location: Pacific Club

A new venue of Pacific Club was used. The change of atmosphere was appreciated by the participants. 

A further review of non organic finding was prompted by requestsf from members for a followup to last meeting by Dr. Stephen Demeter in which he summarized a journal article reviewing literature on the meaning of nonorganic physical signs. The results of this review were surprising. The authors offered conclusions that seemed counter to the conventional interpretation of these signs. For this March 8 meeting, a critical analysis of this paper was provided by Dr. Lorne Direnfeld. The original Waddell paper and some of Dr. Waddell's replies to critics were also reviewed.  

Issues including the "organic vs psychogenic/functional" debate were brought into relief with a discussion of a fascinating paper examining the results of functional MRI studies in patients with conversion disorders. Reversible abnormalities are seen in these studies. Their presence does not imply organic pathology. 

There was full participation in the discussion by all attending, with psychological, occupational medicine, orthopedic, neurologic and chiropractic perspectives, among others, in the mix.

As Waddle has said in a recent book, "The concept of illness behavior is fundamental to understanding low back pain and disability and its clinical management. It is one of the keys to treating people rather than spines."

Meeting (#17) November 5, 2007
Topic: General Membership Meeting
Mostly organizational issues were discussed, some educational issues including upcoming 6th edition of guides as well as WC procedural issues were discussed.

 

 

 

 

Now past history, Those that attended felt it was a high quality program

AMERICAN BOARD OF INDEPENDENT MEDICAL EXAMINERS (ABIME)
In association with Academy of Independent Medical Examiners Hawaii, (AIMEHI)

Presents
ONE DAY WORKSHOP FOR CASE MANAGERS AND ADJUDICATORS
Honolulu, Hawaii February 22, 2002
How to Identify Quality Independent Medical Examinations and
Use Them to Your Advantage

You asked for it!, Hawaii told us you wanted a course covering these topics. Well here it is. The main presenter, Dr. Ranavaya from the mainland ABIME is the international expert in these subjects and literally is one of those who "wrote the book". Don’t miss one of the true "high Maka Makas" coming just for us.

8:30am-8:45am Welcome and Introduction
8:45am-10:00am Use and Misuse of AMA Guides (5th Edition) .
How to Identify the Abuse of the Guides.
10:00am-10:15am Coffee Break (Coffee and Pastries Included in Registration)
10:15am-12:00pm Emperor has no Clothes On!!
Controversial Diagnosis Update.
Fibromyalgia, Myofascial Pain, Multiple Chemical Sensitivity
12:00pm-1:15pm Lunch (cost of Lunch is included in registration)
1:15pm-2:15pm Return to Work Issues in Disability Claims.
How to Meet the Challenges.
2:15pm-2:30pm Break
2:30pm Door prizes awarded
2:35pm-3:30pm Panel discussion

The Panel format is audience questions and panel discussion of the answers. Just to get things started, it will begin with the provocative question of "In Hawaii, When is an Independent Examination not truly "independent" and what do you do about it?"

Panel Members:
Mohammed Ranavaya MD, President-Elect of American Board of Independent Medical Examiners.World-renowned expert in Disability and Independent Medical Examinations. Dr Ranavaya is also the main presenter of the lecture material. He is truly a superstar in his field. Primary contributor to the AMA Guides to Evaluation of Permanent Impairment. Also primary contributor to Official Disability Guidelines.

Mark Stitham MD, Prominent local forensic Psychiatrist, and member of AIMEHI.

Chet Nierenberg MD, Director of Honolulu Sports Medical Clinic and president
of AIMEHI.

Attorney Randy Chung, of Matsui, Chung ,Sumida, and Tsuchiyama. Prominent and Experienced Defense Attorney.

Attorney Dan Colon, Prominent Plaintiff Attorney, previously a Defense Attorney.

Where? Pagoda Hotel
Who? Both ABIME and AIMEHI are cosponsors. Both are non-profit organizations.

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