Dr. David B. Adams – Psychological Blog

Psychology of Illness, Pain, Anxiety and Depression

Psych-IME as a Functional Capacity Exam

I referred to it as _an in vivo mini-functional capacity exam,_ and a side benefit for a Psych-IME.

As important as the results of a Psych-IME may be, the response of the patient to the scheduling and completion of the exam is also critical.

Patients who resist (anger and/or failure to show for) the exam, and obstruct it, are attempting to hide information.

Also, a patient may be told that he/she cannot sit for any more than very brief periods and, as a result, the patient is disinclined to consider transitional_duty work options, stating: _they want me to sit at a desk but even riding in a car for ten minutes is impossible._

However, most of the patient sent for psychological IME, pre- or post-surgical exam, or for an initial psychological opinion, travel two hours to this office. They are then in the office from 4-6 hours, and then they drive or ride two hours in order to get back home.

Many/most of these patients decline breaks when offered, sit for hours at a time, exhibit no pain behaviors, and demonstrate that they have the functional capacity of performing clerical tasks (including travel) of 8-10 hour day.

Are these patients then malingering? Many are not malingering; they merely have misidentified their ability, their residual capacity, and while isolated in their homes, sedentary and medicated, they fail to recognize their own abilities.

Thus the psychological exam becomes not only a means of obtaining a better understanding of the patient_s motivations, it also permits the patient to witness their true limitations_and lack thereof.

It may also be the only setting in which their underlying concerns, frustrations, fears and expectations are openly presented by them.

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