AMA Guides® Newsletter - Issue Archive

Articles

1. Thrombotic and Hemorrhagic Disorders

   Stephen L. Demeter

   Pages 1–4

   DOI: 10.1001/amaguidesnewsletters.2011.SepOct01

   Abstract

   The fourth edition of the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) devoted only a single page to the rating of thrombotic and hemorrhagic disorders, based primarily on analogous impairments from other organ systems and impairments in the activities of daily living (ADLs). The AMA Guides, Fifth Edition, rated thrombotic disorders by the effects on the organ system; criteria for rating hemorrhagic and platelet disorders were based on the treatment required and interferences in ADLs. The sixth edition introduced significant changes, among which are the following: The ratings for hematological disorders were deliberately reduced, especially the highest ratings, because of the inevitable involvement of other organ systems. The goal is for evaluators to rate each organ system based on its defined criteria rather than combining multiple organ system difficulties into a single organ system rating. Also in the AMA Guides, Sixth Edition, separate tables are used to rate hemorrhagic conditions caused by platelet disorders, hemophilia, and clotting disorders. Further, major changes were required because of global methodological changes in this edition, including a significant expansion of the methodology used in rating clotting defects. Finally, the rating for the use of warfarin was altered, and thrombotic disorders are rated using the specific coagulation defect.
   Show more

2. Sixth Edition and Illinois

   Christopher R. Brigham

   Pages 5–5

   DOI: 10.1001/amaguidesnewsletters.2011.SepOct02

   Abstract

   The state of Illinois has undergone major workers’ compensation reform with the passage of House Bill 1698, and from September 1, 2011, one of the factors used to determine a permanent partial disability (PPD) rating is an impairment evaluation according to the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Sixth Edition. Previously, the Illinois Workers’ Compensation Commission used a body of case law that set forth general parameters to guide PPD assessment, and the Commission would not allow testimony for any doctor's opinion regarding the percent of disability. Adding the use of the AMA Guides should increase the reliability of these awards. Impairment rating is only one factor that will be considered in determining the level of PPD, and other factors include the injured employee's occupation; age at the time of injury; the employee's future earning capacity; and evidence of disability corroborated by the treating physician's medical records. No single factor should be the sole determinant of disability, and the fact finder must use judgment and must document the rationale for the decision. Basing the impairment rating on the AMA Guides as a starting point should result in both a more valid and more reliable process to determine PPD.
   Show more

3. Behavioral Factors Impact Impairment and Disability Evaluation

   Lee Ensalada

   Pages 5–7

   DOI: 10.1001/amaguidesnewsletters.2011.SepOct03

   Abstract

   Illness behavior refers to the ways in which symptoms are perceived, understood, acted upon, and communicated and include facial grimacing, holding or supporting the affected body part, limping, using a cane, and stooping while walking. Illness behavior can be unconscious or conscious: In the former, the person is unaware of the mental processes and content that are significant in determining behavior; conscious illness behavior may be voluntary and conscious (the two are not necessarily associated). The first broad category of inappropriate illness behavior is defensiveness, which is characterized by denial or minimization of symptoms. The second category includes somatoform disorders, factitious disorders, and malingering and is characterized by exaggerating, fabricating, or denying symptoms; minimizing capabilities or positive traits; or misattributing actual deficits to a false cause. Evaluators can detect the presence of inappropriate illness behaviors based on evidence of consistency in the history or examination; the likelihood that the reported symptoms make medical sense and fit a reasonable disease pattern; understanding of the patient's current situation, personal and social history, and emotional predispositions; emotional reactions to symptoms; evaluation of nonphysiological findings; results obtained using standardized test instruments; and tests of dissimulation, such as symptom validity testing. Unsupported and insupportable conclusions regarding inappropriate illness behavior represent substandard practice in view of the importance of these conclusions for the assessment of impairment or disability.
   Show more

4. Book Review: AMA Guides to the Evaluation of Ophthalmic Impairment and Disability, Measuring the Impact of Visual Impairment on Activities of Daily Life

   Bernard R. Blais

   Pages 7–8

   DOI: 10.1001/amaguidesnewsletters.2011.SepOct04

5. Questions and Answers

   Christopher R. Brigham, Charles Brooks, Mohammed Ranavaya, James B. Talmage, Marjorie Eskay-Auerbach, Craig Uejo

   Pages 8–9

   DOI: 10.1001/amaguidesnewsletters.2011.SepOct05