When a diagnosis is in dispute for a healthcare professional, an independent medical exam (IME) is often ordered. This is an evaluation that is done by an external physician who assesses the individual with respect to their diagnosis and treatment plan, offering recommendations for next steps. They are sometimes requested by governing colleges, insurance companies, medical departments (with respect to staff), etc. One rarely asks for an IME for themselves.
The patients that I meet may be seen by a psychiatrist or an addictions specialist.
These evaluations can be long (more than a few hours) because they cover a lot of information. The assessor will usually request all available medical information from your providers including tests, clinical notes, and any discharge summaries. Sometimes they will request their own labs, or ask to speak to your family or colleagues. They are trying to get a 360’, objective view of you and your addiction history. This is an opportunity for your treatment team to have fresh eyes to help us determine the best way to help you.
The evaluator is not part of your treatment team. They will not prescribe you medications and their recommendations are viewed as suggestions for your own addictions and family physicians. They will hear some of your biggest secrets. They have heard it all, don’t be worried about being judged. Remember, they are here to help the team pick through all the facts to help us know what is important in your care.
The evaluation can be very overwhelming. For many who have not yet dealt with the shame of being a health professional with addiction, it may feel accusatory. Issues that you have not dealt with previously such as trauma may also be raised. They will talk about personal relationships, past and present, what work is like for you, your mental health, and addiction.
There are a few recommendations for making sure that you are ready for your evaluation.
Give yourself plenty of time. If you need to get to an office, make sure that you have at least an extra hour to get there. Starting the evaluations after hunting for parking and racing up 4 flights of stairs can make an already stressful day even harder.
Make up a list of your timeline as you see it. Think about your substance use history, your work history, and how they are connected. Prepare a timeline for both (things like when you graduated, from where, what your first job was, etc. and when you first started using any substances at all, your relationship with alcohol, marijuana, opiates, stimulants, etc.) If you’re feeling particularly generous, bring an extra copy for your evaluator to look at/keep. It may be hard seeing all of this in black and white. Do this ahead of time so that you can add to it as you remember things, but also to give you time to process what is on your timeline.
Dress the way that you would for a job interview. It truly doesn’t matter how you dress, but that kind of outfit will help put you into a professional mindspace.
If your IME is done virtually, by the phone or video, still get dressed up. Make sure all distractions are turned off (your phone is silenced, all other computer windows are closed) and that anyone you live with knows that you aren’t to be disturbed. If there is an issue with childcare or eldercare, be sure to warn the evaluator at the beginning of the session. If by phone, consider finding a photo online of the evaluator so you can feel as though you are talking to them directly, your smile will translate into the tone of your voice on the phone.
Have an aftercare plan ready. This can be an emotionally taxing day. Be sure to have a non-judgemental friend that you can debrief with following the evaluation. Take care of yourself, have a nap, go for a walk. Plan to keep busy. If you find yourself dwelling on the evaluation (even parts of it), reach out for help. It would be terrible if you relapsed after an IME.
Your IME is another way for us to help keep you well. It is one piece of your recovery. You’ll get out of it what you put into it.
Ask your case manager or addictions physician if you have any questions about the process. Your Caduceus group will be able to be supportive as well. If you have a sponsor, let them know that this is about to happen and they may have some suggestions for step work that can help you prepare.