IMO Newsletter “Chronic Fatigue Syndrome: Facts vs Fiction” Seminars wrap-up (with resources)

This IMO Newsletter article provides an update on the recent seminars on “Chronic Fatigue: Fact vs. Fiction” held in Sydney and Melbourne. The intention is that this post-seminar report will be a useful resource and act as a primer for further education of our clients and clinicians in this topic area.

As we stated in the invitation emails for these Sydney and Melbourne seminars we believe that CFS is hard to diagnose and manage clinically, presents many challenges for an IME, and is hard to prosecute/defend for a legal case.

Goal: Facilitate discussion of the issues for medico-legal cases involving Chronic Fatigue Syndrome and explore the role of an IME in these cases…

Objective: Increased knowledge of CFS/ME (clinical facts not fiction!)..aiming to understand what is relevant in improving case management referrals.

The reference material includes both medical and legal ‘opinion’ (based on facts) but unfortunately cannot provide the depth or variety of discussion of these facts and the ‘fictions’ during the seminar.

The content on the IMO Blog includes links to the seminars’ PowerPoint presentation and a document of references used in preparation of the seminars with bibliography resource material which we believe should be a useful resource for our clients, including Case Managers, Lawyers, Injury Management Advisors and IME medico-legal consultants. It may also be downloaded as an IMO Pty Ltd copyright document for private study and/or organisation-wide information libraries.

Audience participation was expected and we enjoyed robust discussion during the interactive seminar between IMO specialist consultants, legal practitioners and a variety of insurers’ representatives from varied health professional and case management backgrounds in both Sydney and Melbourne.

Interactive Seminar discussion points
1. IMO preliminary research of the topic ‘Chronic Fatigue Syndrome’ identified that the clinical facts and fiction on the Internet are potentially conflicting and of large volume unrelated to the quality of the content. Judicious information filtering is needed to source high-quality information for CFS/ME education use and particular use in decisions about medico-legal case issues.

A clinical services review by IMO Executive staff and medico-legal consultants developed the slide set and additional references for initial Sydney & Melbourne seminar presentations in-person and for online self-education.

2. We engaged in both seminars (Sydney & Melbourne) in a spontaneous but brief discussion of the role of General Practitioners in diagnosis and management of Chronic Fatigue Syndrome & related medically unexplained physical symptoms, particularly given their key role as Nominated Treating Doctors in compensation claims cases.

A piece of follow-up work by IMO Pty Ltd with colleagues in the various Clinical Colleges and University Medical Faculties will follow to discuss and understand the current & future education of junior doctors re: medico-legal training and education.

As we move from a base of mainly musculoskeletal injuries to bio-psycho-social ‘injuries’ there seems to be an industry-wide need for improved timely and relevant education and training across all sectors (medical, legal and case management professionals). These interactive seminars are great!!!

3. An intensive but short discussion of ‘somatisation’ of illness, the ‘sick role’ and ‘secondary gains’ was interesting and engaged many individuals who wanted further information &/or education (e.g., refer to individual slide references).

The variety of syndromes and disorders is further complicated by changing definitions, such as those recently adopted for the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) re: Somatic Symptom Disorders.

It was noted that the new DSM5 classifications have no relevance for Independent Medical Examination opinions (except for a psychiatric opinion as collateral information)….and therefore the re-classification of clinical cases within the new ‘Somatic Symptom Disorder’ is of interest but problematic for insurance companies and individual claimants (with SSD illness) in particular.

4. The details of a long-running series of cases re: Dixon vs. Whinsprun were concisely reviewed (refer slides by Peter Riddell, Turks Legal) with a comprehensive handout that examines the legal issues in that CFS/ME case from an initial claim for workers compensation post-Q fever.

There are other CFS/ME cases that are not workers compensation (e.g., Life Insurance Policy for Income Protection; Personal Injury etc). Each may be individually unique but collectively this is a new area of legal precedent where the medical diagnosis and case management may face legal challenge with increasing case numbers in the future due to changes in the nature of work and insurance.

5. Physical and mental health medico-legal cases are problematic as the presentation of the case and clinical history can be multiple-speciality. Even when defined within a single specialty the diagnosis may be certain (evidence-based) but difficult to manage for bio-psycho-social reasons involving treatment, rehabilitation and ‘future capacity’ assessment.

The benefits of a comprehensive assessment (e.g., re: work capacity, job matching, earning capacity, functional capacity examination etc.) including psychologists and rehabilitation experts could be best-practice compared to a single-speciality review. This potential practice change is not supported under current policy & regulations, e.g., WorkCover Guidelines, due to the stringent conditions required before requesting an IME & no multiple specialities option.

6. The opportunity is available to ask IMO about SPECIALTY then SPECIALIST for all case referrals for IME and other assessments.

Links to resources: Comprising slides, references & a bibliography from the embedded link below.

PowerPoint: Chronic Fatigue Syndrome Seminar – Click here to download.

References Chronic Fatigue Syndrome Seminar – Click here to download.

Case Summary re Winsprun Pty Ltd v Dixon – Click here to download.

Thanks to following IMO specialist consultants who willingly gave of their time to participate in the seminar discussion on Thursday 12 June 2014 (Sydney) or
Thursday 19 June 2014 (Melbourne):

• Dr Tim Anderson (Occupational Physician): the Sydney presenter
• Dr John SILVER (Occupational Physician): the Melbourne presenter
• Dr Anthony LOWY (Occupational Physician): Sydney participant

Each of the above medical specialists can be contacted through IMO

• Mr Peter Riddell (Managing Partner, Turks Legal, Melbourne): speaker

Future topics for seminars identified as:
a. Mental Health
b. Chronic Pain
c. Effective “IME” Questioning
Facilitator: Steven Tipper, Executive Director Clinical Services, IMO Pty Ltd

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