Matheson Philosophy on Workplace Safety and Work Injury Evaluation

Insight Into How Physicians Determine Effort In The Office: Part 1

There are many resources physicians use to make decisions regarding patient care.  In the arena of Workman’s Compensation cases, particularly when assessing factors such as “effort”, “credibility”, “motivation determination” and functional ability, there are few tools that purport to make determinations such as the Performance APGAR.  According to the original article Motivation Determination (Sincerity Of Effort): The Performance APGAR Model, published in Disability Medicine (Vol. 1, No. 2, September-December 2001), this relatively simple tool can be used to “measure the amount of personal commitment and effort the patient has expended to improve their condition” (Colledge, Holmes, Soo Hoo, et al). 

I first became aware of the Performance APGAR earlier this year when reviewing medical information for an FCE I was to perform.  Essentially, my services were referred in an effort to assess the current function (in addition to assessing Effort and RPDR) and potentially refute the findings of a physician’s IME (Independent Medical Examination) which listed an evaluee’s level of function as significantly disabled.  My findings were significantly different from conclusions of the physician’s, and from those of the Performance APGAR.  This incident led to me investigating further into this tool-how it is used, who uses it, and what it may really “determine”.

The original APGAR was developed by anesthesiologist Dr. Virginia Apgar in 1952 as a simple assessment to quickly assess the health of a newborn child.  The APGAR score is determined by evaluating the newborn baby on five simple criteria on a scale from zero to two, then summing up the five values obtained.  The resulting APGAR score ranges from 0 to 10.  The five criteria that formed the acronym were; Appearance, Pulse, Grimace, Activity, and Respiration-and has changed little since initially developed.  In contrast, the Performance APGAR stands for; Acceptance, Pain, Gut (intuition), Acting and Reimbursement.   

I like to think that most of us evaluators believe that what we do provides very accurate answers to the questions of our referral sources-with particular emphasis on Effort, RPDR (Reliability of Pain and Disability Reports) and demonstrated level of function.  Most of us focus our skills on the area(s) of our expertise and refrain from wandering out of where we are highly skilled and competent.  Typically, we provide information to physicians to help them with the medical management of patients, and the responsibility for medical decisions reside with the doctor.  Reading the abovementioned article has given me insight into what some physicians look for in determining “credibility” and perhaps some insight into how they may think. 

Before we discuss the specific APGAR components, it is important to first discuss a tool that is to be completed before or along with the Performance APGAR (and is a component of “Gut”), the Credibility Assessment Tool.  This tool is used to “make an assessment of allegation credibility for the Performance APGAR score”.  The rater chooses one of the three categories for 5 areas to establish credibility.  The three categories are;

*Not consistent with the objective evidence and/or expected outcome/severity.     (0 points)

*Partially consistent with the objective evidence and/or expected outcome/severity. (1 point)

 *Fully consistent with the objective evidence and/or expected outcome/severity.     (2 points)

The areas covered include;

*Impact of symptoms or condition on ADL’s;

*Type, dosage, effectiveness, and side effects of medications;

*Treatment sought and received; opinions about function given by other treating and examining sources in the file;

*Inconsistencies or conflicts in the allegations, statements or medical evidence in the file.  

The scores for each category are combined with the following 0-10 interpretation;

            *0-3= Not Credible

            *4-7= Partially Credible

            *7-10= Fully Credible

Things get much more interesting when we discuss the individual components of the APGAR-Acceptance, Pain, Gut, Acting and Reimbursement.  A summary of each component will be discussed in next week's blog post. Check back next Tuesday for part two of "Insight Into How Physicians Determine Effort in The Office"!

 

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