Psychological Testing (California)

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Psychological Testing (California)

Postby vampireinthenight on Wed Apr 16, 2014 2:24 pm

Is not psychological testing in conjunction with the evaluation considered necessary? I know each QME has their own battery of tests, but what should I do when a QME performs none of the standard types of tests? Is there some way to assert that at least some of them are necessary to have a complete evaluation?
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Re: Psychological Testing (California)

Postby cmunday on Thu Apr 17, 2014 7:56 am

Vampire

I don't think it is a clear cut issue. First, there's often a difference between the approach of a Ph.D. Psychologist and an MD Psychiatrist. Psychologists of course are much more likely to utilize tests because it's foundational to much of what we do. Technically, most psychiatrists are not equipped to interpret tests beyond simple surveys and this is why you will usually see computerized interpretations of things like the MMPI or MCMI. Alternatively, many psychiatrists will have tests "blindly" interpreted by a psychologist.

There are some conditions where I don't think tests are necessary to properly evaluate and other conditions where tests are absolutely crucial (any dementia or cognitive dysfunction for example). On a case by case basis I think you might argue that an examination is not "substantial evidence" if testing is not utilized. I personally always err on the side of caution. Recently had several cases that dragged on and the person returned 4 years later or so to get a current evaluation even though I called them MMI previously and no evidence that anything has changed. I explained to the person that I have no doubt that their condition has remained stable but that it's important for me to document with repeat testing to make sure the system does not balk. The patients understand this and frequently say something such as "Doc, I want this over. Please do whatever you need to do to try to wrap this up".

If you have a relationship with a psychologist or psychiatrist why not run the specific case by him/her for guidance? Maybe consult on salient points to ask in a deposition?
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Re: Psychological Testing (California)

Postby psych74 on Thu Apr 17, 2014 6:59 pm

I agree with Dr. Munday and would add that applicants will often tell you things on psych. testing that they not tell you in person and (vica versa). Nevertheless, I have done non-WC med-legal IMEs where I was told that psych testing was not authorized under any circumstances by the carrier and can still provide substantial evidence. It usually takes longer to do the clinical interview under those circumstances because I am asking some questions that normally would be covered on testing. I have done brief cognitive testing and told the referral source that more is required to answer some questions with reasonable medical probability. However, if the DX is something like Major Depressive Disorder, psych testing would not be absolutely necessary.
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Re: Psychological Testing (California)

Postby vampireinthenight on Fri Apr 18, 2014 9:23 am

Thank you both for your responses. It is situations like these where having only one QME drives me nuts. I'm not trained to say so, but I know this particular person has an underlying personality disorder. I've got 10 witnesses describing odd behavior, pathological lying (specifically, lying in situations even when there is nothing to personally gain) and some grandiose self perceptions. It was clear to me when I deposed this person that something was "off", but the QME just concludes no underlying personality disorders. I could guarantee something would be revealed on testing, but I don't know how to force the issue!
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Re: Psychological Testing (California)

Postby psych74 on Sat Apr 19, 2014 12:18 pm

I have been asked to review witness statement in initial QME evals or supplemental reports. Otherwise deposition might be an option.
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Re: Psychological Testing (California)

Postby vampireinthenight on Mon Apr 21, 2014 8:17 am

Yeah, that's the plan. Is there an authority which says that disparities in accounts from other people in an individual's life is strong evidence of a personality disorder?
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Re: Psychological Testing (California)

Postby cmunday on Mon Apr 21, 2014 1:47 pm

Vampire

I would ask about the specific observations you have from others ad nauseum (in a deposition I mean). And ask what evidence would be necessary to diagnose a personality disorder. I would ask if the Dr. would consider psychological testing in order to thoroughly investigate this issue. Don't know the Dr. of course but many of my colleagues would respond to "Dr. I'm sure you'd agree with me that the goal should be to accurately gauge disability and to appropriately consider apportionment. Given some of the statements I've provided would you be willing to reconsider the apportionment issue and perhaps investigate further with psychological testing?" Hard to answer "no" without sounding like an ideologue or worse and I think you might well argue that the report is not substantial evidence given the doctor's refusal.

Also, either study DSM-IV and phrase your questions vis-a-vis specific personality disorder symptoms liste or again have a mental health person you trust give you some guidance. None of us likes to admit we didn't get it right but if you give a reasonable person an out "Dr. I realize you did not have this information available to you before and assumed you want to re-evaluate with this new data"..........

Unless the Dr. is an idiot a direct frontal assault is never effective. I once read a deposition where the applicant attorney opened with "Dr. isn't it true that you find malingering far more often than any of your colleagues and that's why you've developed such a following by the defense bar?" You can predict the gist of the answer to this "question".
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Re: Psychological Testing (California)

Postby psych74 on Mon Apr 21, 2014 5:28 pm

I would also suggest reviewing pages 685-689 of the DSM-IV-TR Textbook for a general overview of Personality Disorders. I have seen a
number of applicants where significant pre-existing Mixed Personality Traits were a consideration in either Causation and/or Apportionment determinations. Interpersonal functioning is so important in the workplace (and elsewhere for that matter).
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Re: Psychological Testing (California) (California)

Postby appliedpsych on Mon Apr 21, 2014 8:59 pm

Just remember that things like being a jerk, an a**hole, a wallflower, a doofus or a dweeb does not mean a personality disorder.

The controlling factor is "behavior that markedly deviates from the expectations of an individuals culture".

Also the ability to hold a job for a decent period of time can be a marker that would point away from a personality disorder.

Many times lower IQ, such as that in the range of borderline intellect, can be misinterpreted as a PD, when it is really just low intellect, and the poor coping and reasoning skills that go with that.
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Re: Psychological Testing (California)

Postby vampireinthenight on Tue Apr 22, 2014 8:13 am

Unless the Dr. is an idiot a direct frontal assault is never effective. I once read a deposition where the applicant attorney opened with "Dr. isn't it true that you find malingering far more often than any of your colleagues and that's why you've developed such a following by the defense bar?" You can predict the gist of the answer to this "question".


Haha, yes I like to think I have more tact than that! Thanks for the depo suggestions.

I would also suggest reviewing pages 685-689 of the DSM-IV-TR Textbook for a general overview of Personality Disorders.


Thanks, I will check that out.

Just remember that things like being a jerk, an a**hole, a wallflower, a doofus or a dweeb does not mean a personality disorder.


Good to remember. From a QME's perspective, would you guys apportion to jerky behavior even if it did not arise to a personality disorder? I know my question is a little broad...
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