QME mine > module 10 whole deck > Flashcards

module 10 whole deck Flashcards

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1
Q
A
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2
Q

What is the primary ethical duty of a QME?

A

To remain objective and impartial, providing accurate, evidence-based opinions regardless of who pays or benefits.

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3
Q

Why is impartiality critical for QMEs?

A

QME opinions drive legal outcomes; bias can invalidate reports and destroy credibility.

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4
Q

Mnemonic for QME duty

A

FAIR FACTS FIRST.

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5
Q

What is a conflict of interest for QMEs?

A

Any personal/financial/professional tie that could influence objectivity (e.g., treating relationship, business ties).

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6
Q

What must a QME do if a conflict exists?

A

Disclose immediately and recuse if impartiality may be compromised.

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7
Q

Can a QME treat the same worker they evaluate?

A

Generally no — dual roles create conflict.

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8
Q

What is the QME’s duty of confidentiality?

A

Protect PHI; disclose only with proper authorization or legal mandate.

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9
Q

Mnemonic for confidentiality

A

HIPAA = Hold Info Private, Ask Authorization.

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10
Q

How does HIPAA apply to QMEs?

A

Safeguard PHI; share only with authorized entities (insurer, WCAB) as allowed.

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11
Q

When can a QME disclose without consent?

A

When required by law (subpoena, court order, mandated reporting).

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12
Q

What is ex parte communication?

A

Contact with one party without the other’s knowledge; generally prohibited.

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13
Q

Why avoid ex parte contact?

A

It can invalidate the QME report and trigger sanctions.

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14
Q

Mnemonic for ex parte rule

A

NO SOLO TALK.

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15
Q

What if one side sends undisclosed records?

A

Disclose, provide to the other party, and document in the report.

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16
Q

QME obligation in testimony?

A

Be truthful, objective, and stay within medical evidence/expertise.

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17
Q

How should a QME prepare for deposition?

A

Review the record/report, know your rationale, and keep neutral tone.

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18
Q

What is the duty to the court?

A

Assist the WCAB with unbiased medical opinions framed in medical probability.

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19
Q

Define misrepresentation in med-legal reporting.

A

Falsifying/omitting evidence or tailoring opinions to a party.

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20
Q

Consequences of misrepresentation?

A

Sanctions, decertification, civil liability, possible criminal fraud.

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21
Q

Mnemonic for honesty

A

FACT OVER FAVOR.

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22
Q

Why document thoroughly?

A

Defensible notes sustain credibility and withstand cross-examination.

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23
Q

Core contents of a defensible report?

A

History, exam, records reviewed, objective findings, reasoning, causation, apportionment, MMI/PD.

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24
Q

Handling patient dissatisfaction?

A

Stay professional; explain QME’s neutral role; don’t advocate.

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25
Can a QME act as patient advocate?
**No** — evaluator only.
26
Mnemonic for role
**NEUTRAL, NOT ADVOCATE.**
27
Why avoid casual comments/jokes in med-legal settings?
They can be misread and erode impartiality.
28
Ethical standard for **billing**?
Bill **accurately** for services actually performed; follow fee schedule.
29
Mnemonic for billing
**BILL TRUE.**
30
What is **dual representation**?
Acting as QME and consultant/advocate for a party — prohibited.
31
Why is **informed consent** needed in QME exams?
Patient must understand purpose, limits of confidentiality, and non-treatment role.
32
If patient refuses exam post-consent?
Document refusal and notify the requesting party; do not coerce.
33
What is **scope of practice**?
Stay within your specialty; avoid out-of-scope opinions.
34
Mnemonic for scope
**KNOW & NO GO.**
35
Danger of **speculative opinions**?
Weakens credibility; can be stricken.
36
Administrative sanctions for ethics breaches?
Suspension/removal from panel, fines, reporting to the medical board.
37
QME duty re **fraud detection**?
Document and **report** credible fraud indicators to appropriate authorities.
38
Mnemonic for fraud duty
**SEE IT, SAY IT.**
39
Can a QME ignore falsified history?
No — document inconsistencies and base conclusions on objective evidence.
40
Why refuse **gifts/perks** from parties?
Creates bias appearance; violates ethics/labor code.
41
Mnemonic for gifts
**NO GOODIES.**
42
Rule for **record handling**?
Secure storage, track custody, protect PHI in transit.
43
Typical **record retention** period?
**≥5 years** (check current state/QME regs).
44
Why use **objective language**?
Reduces bias and supports legal defensibility.
45
Biased vs objective example
“Liar” ❌ vs “Statements conflict with prior records” ✅.
46
What is **deceptive advertising**?
Misstating qualifications/outcomes or promising favorable opinions — prohibited.
47
**Expert witness immunity** for QMEs?
Limited; unethical behavior can still be sanctioned.
48
Why is **timeliness** ethical?
Delays harm case progress and breach duty to the tribunal.
49
Mnemonic for timeliness
**FAST FACTS.**
50
Take a case beyond capacity?
**Decline** if you can’t complete thoroughly and on time.
51
**Record review integrity** means?
Review **all** records; don’t cherry-pick.
52
Handling **incomplete records**?
Note gaps, request missing items, state limits on conclusions.
53
Ethical stance on **contingent payment**?
Prohibited — fees must not depend on case outcome.
54
Attorney **coaching** attempts?
Decline, document pressure, maintain independence.
55
Mnemonic for resisting coaching
**STAND FIRM.**
56
Rules on **referrals** from parties?
Accept only if impartiality remains intact; refuse if expectation of bias.
57
Disclose **prior involvement**?
Yes — prior treating/consulting is a potential conflict.
58
Accidentally treat after evaluating?
Withdraw and disclose to parties.
59
Define **independent medical judgment**.
Opinion based **solely** on evidence and expertise, free of influence.
60
Mnemonic for independence
**OWN YOUR OPINION.**
61
New evidence after report?
Review, issue a **supplemental** addendum, provide to both sides.
62
Are **rushed exams** ethical?
No — thoroughness is required for fairness.
63
Why avoid **excessive fees**?
Appears exploitative; invites DWC scrutiny.
64
Mnemonic for fair fees
**FAIR FEE, FREE OF GREED.**
65
Patient offers **bribe**?
Decline, document, and report if appropriate.
66
Handling **aggressive parties**?
Stay calm, document intimidation, keep objective stance.
67
Define **unprofessional conduct**.
Rudeness, discrimination, harassment, biased remarks or behavior.
68
Bias in **psych cases**?
Guard against stigma-based bias; stick to evidence.
69
Mnemonic for bias control
**FACTS OVER FEELINGS.**
70
Duty if **danger to self/others** emerges?
Follow **Tarasoff**/duty-to-warn/report laws; safety over secrecy.
71
Tarasoff vs confidentiality?
Duty to protect can **override** confidentiality.
72
If evaluation is limited (poor effort, etc.)?
Describe limitations and their impact on conclusions.
73
Avoid **personal opinions** unrelated to medicine?
Yes — they undermine objectivity.
74
Mnemonic to stay on topic
**STAY IN SCOPE.**
75
Advertising **success rates**?
Prohibited; outcomes marketing implies bias.
76
**Late cancellation** fees?
Only if allowed/reasonable; disclose policy upfront.
77
Why maintain **professional demeanor**?
Preserves credibility with WCAB, attorneys, and patient.
78
If patient **secretly records**?
Proceed professionally; document recording; laws vary.
79
Provide **legal advice** to patient?
No — outside medical role; refer legal questions appropriately.
80
Scope reminder mnemonic
**MEDICAL ONLY.**
81
Ethical handling of **language barriers**?
Use certified interpreters; document interpreter identity.
82
Obligation for **cultural sensitivity**?
Respect differences and document relevant cultural factors objectively.
83
Mnemonic for cultural respect
**SEE CULTURE CLEARLY.**
84
Jokes about race/gender/disability?
Never — invites complaints and shows bias.
85
Managing **patient anger** during exam?
Stay calm, set boundaries, document behavior factually.
86
Personal relationships with parties?
Avoid — friendship/dating compromises neutrality.
87
Mnemonic for boundaries
**NO FRIEND ZONE.**
88
Disclose prior **employment with insurer/firm**?
Yes — financial ties may be COIs.
89
Unsure about a potential COI?
Disclose and seek DWC guidance.
90
**Social media** commentary on cases?
Avoid; risks confidentiality and sanctions.
91
Ethical stance on **record alteration**?
Never alter/destroy; correct via transparent addendum.
92
Avoid **overpromising** outcomes?
Yes — stick to supportable medical probabilities.
93
**Dual agency** risk?
Evaluator + treater roles conflict; avoid.
94
Disclose **malpractice history** when required?
Yes — honesty maintains panel eligibility.
95
Maintain **continuing education**?
Keeps opinions current and defensible.
96
Mnemonic for CME
**LEARN TO LAST.**
97
Mistake in report discovered?
**Own & amend** with prompt addendum to both parties.
98
If patient reports a **new work injury**?
Document; clarify scope; direct to proper channels.
99
Unqualified for **mental health** assessment?
Don’t opine beyond training; refer appropriately.
100
Keep exam setting **professional**?
Yes — fairness, comfort, and credibility depend on it.
101
Employer asks for **off-the-record** views?
Decline; all case opinions must be documented/shared.
102
**Rush job** for one party?
Decline if it compromises neutrality/thoroughness.
103
Neutral tone in **psyche reports**?
Essential to avoid perceived partisanship.
104
Pressured to **omit history**?
Refuse; include all relevant facts.
105
Mnemonic for completeness
**FULL FACT FILE.**
106
Why state **evaluation limits**?
Transparency protects against overreach claims.
107
Rules on **follow-up exams**?
Provide if medically necessary/ordered; document rationale and bill properly.
108
Missing **test results**?
Note unavailability; request rather than guess.
109
Why is **clear reasoning** vital?
Judges rely on explicit logic to sustain opinions.
110
**Financial transparency** duty?
Disclose fees; follow fee schedule; no hidden charges.
111
Why avoid **kickbacks**?
Illegal/unethical; risks decertification and penalties.
112
**Expert credibility** pillars?
Objectivity, complete review, clear reasoning, honesty under oath.
113
Mnemonic for credibility
**FACTS + FAIR = TRUST.**
114
Avoid **jargon overload**?
Yes — clarity improves legal utility.
115
Value of **peer review**?
Improves quality and defensibility.
116
Professional communication with attorneys?
Prevents ex parte issues; keeps the record clean.
117
If attorney tries to **limit report**?
Decline; duty is to present full unbiased findings.
118
Document **all sources** used?
Yes — “**Show your work**” for transparency.
119
Patient **threatens legal action** in exam?
Stay calm, document, proceed professionally, notify as needed.
120
Avoid expressing **anger/frustration**?
Yes — unprofessional tone undermines credibility.
121
Define **secondary gain** and how to note it.
Non-medical benefits of claim; document objectively, avoid bias.
122
Label **malingering** only when?
When supported by valid tests and clear inconsistencies.
123
Mnemonic for caution
**PROVE IT OR DON’T SAY IT.**
124
New party **questions** post-report?
Answer within scope via supplemental report if appropriate.
125
**Email privacy** standard?
Use secure channels; minimize PHI; comply with HIPAA.
126
Avoid **political/personal opinions**?
Yes — they signal bias.
127
What is **implicit bias**?
Unconscious bias; actively monitor and minimize it.
128
Mnemonic for bias check
**CHECK SELF.**
129
Clarify **testing limitations**?
Yes — prevent overinterpretation and maintain accuracy.
130
Handling **hearsay evidence**?
Note it as unverified; base conclusions on objective data.
131
Keep **contact logs**?
Yes — track communications; prevent ex parte disputes.
132
Insurer requests an **“informal call”**?
Decline or include all parties and document.
133
Secure **physical/electronic files**?
Yes — encryption/locked storage; protect PHI.
134
Define **chain of custody**.
Documented handling trail ensuring record integrity.
135
Humor/sarcasm in legal settings?
Avoid — easily misread and harmful.
136
Duty when **new laws/regs** emerge?
Stay updated and integrate changes in practice.
137
Mnemonic for updates
**KNOW THE NEW.**
138
**Ethics CME** value?
Maintains compliance and panel eligibility.
139
Subpoena requests **beyond scope**?
Produce only relevant records; seek counsel if unclear.
140
Avoid **disparaging colleagues**?
Yes — stick to objective differences.
141
Handle **unclear legal requests** how?
Ask for clarification from DWC/counsel before acting.
142
Ethical stance on **copy-paste** from old reports?
Only if accurate, updated, and relevant; otherwise rewrite.
143
Disclose **validity limits** of tests?
Yes — protects against misuse of results.
144
Manage **confidential third-party info**?
Include only relevant, authorized details; redact otherwise.
145
Avoid **diagnosing without evidence**?
Yes — base diagnoses on exam and data.
146
If **illegal activity** discovered?
Document; report when mandated (e.g., abuse), remain objective.
147
Maintain **calm under cross-exam**?
Yes — professionalism preserves credibility.
148
Mnemonic for composure
**CALM = CRED.**
149
Why avoid accepting **extra compensation** for quicker report?
It suggests bias; violates fee rules and ethics.
150
Clarify **causation vs legal conclusions**?
Provide medical causation; let WCAB apply legal standards.
151
Mnemonic for boundary
**MED FACTS, LAW LATER.**
152
Avoid **treating** after evaluation?
Yes — creates conflict; withdraw if treatment occurs.
153
Handling **impaired capacity** patients?
Assess capacity, simplify explanations, document limitations.
154
Keep **backups** of reports?
Yes — safeguard against loss and for legal requests.
155
Correct **errors after submission**?
Issue a prompt, transparent **addendum** to both parties.
156
Note **methods used** (tests/tools)?
Yes — transparency supports validity.
157
Personal **gain** from case outcome?
None — opinions must never depend on result.
158
Document **time spent**?
Yes — supports billing integrity and thoroughness.
159
Handle **press/media inquiries**?
Decline; protect confidentiality; refer to counsel/DWC.
160
Review **state QME regs** regularly?
Yes — stay compliant as rules update.
161
Mnemonic for reg checks
**READ REGS REGULARLY.**
162
Telemedicine **ethics** for QME?
Use when appropriate, verify identity, ensure privacy, document limitations.
163
Chaperone for **sensitive exams**?
Offer/arrange when appropriate; document presence.
164
Provide **reasonable accommodations**?
Yes — for disabilities during exam/testing; document adjustments.
165
Conflicts over **exam location/scheduling**?
Choose neutral, accessible settings; avoid party-controlled venues.
166
Secure **devices** (laptops/USB) with PHI?
Encrypt, password-protect, and limit access.
167
Data **destruction policy**?
Follow legal retention periods; document secure disposal.
168
Retain **raw testing data** how long?
Per regulation and test publisher rules; document retention.
169
Consent for **audio/video recording**?
Obtain and document; explain purpose and limits.
170
Incidental **non-industrial findings**?
Inform patient appropriately and **refer**; don’t overreach.
171
Duty to **refer emergent conditions**?
Yes — ensure timely referral/ER if urgent risk identified.
172
Use of **standardized questionnaires**?
Allowed; disclose tools used and interpret within limits.
173
Handling **party-requested edits**?
Consider factual corrections; reject biased edits; document changes.
174
Pre-approval of **draft reports** by parties?
Prohibited; finalize independently, then distribute to both sides.
175
**E-signatures** on reports?
Acceptable if secure and auditable; no stamp-only signatures.
176
Subpoena for **raw psych data**?
Comply per law/publisher rules; consider releasing via qualified professional.
177
Charging for **test materials**?
Bill per schedule; no markups beyond allowed costs.
178
Direct contact with **treating physician**?
Only with both parties informed/consenting; document the contact.
179
If **interpreter quality** is poor?
Stop, request certified interpreter, document reason for reschedule.
180
Final ethical takeaway for QMEs
**Stay neutral, transparent, evidence-based, compliant — and write like a judge will read every line.**
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