Patient: It was a 3-car pile up. The woman that was in front of me was completely stopped. I had stopped behind her, but the woman behind us didn't and plowed into the back of me.

Dr. Michael Franchetti: I'm trying to find out the extent of any injuries that a patient may have sustained. When I do an Independent Medial Evaluation, I am asked either by the patient's attorney or by insurance companies to express the whole gamut of opinions, whether the accident caused the injury in question, the extent of permanency of any injuries that a patient may have suffered. Does this patient who still has these findings and complaints, do they need any more treatment or management?

Any pain when I press here?

Patient: No.

Dr. Michael Franchetti: Any pain over here?

Patient: Yes.

Dr. Michael Franchetti: More on the right side.

Patient: It still very much about this, especially when I turn to the right.

Dr. Michael Franchetti: If the history doesn't fit the examination, that should raise a red flag. If a patient was complaining of numbness radiating down their arm or leg we would expect some findings consistent with a pinch nerve, whether it be loss of strength or abnormal reflexes. If you palpate very lightly the skin over an area and the patient is wincing in pain, that would be inconsistent with injury to the underlying muscles.

Any pain when I do this?

If you lightly press on the top of the skull and they complain that their back hurts or they have severe pain in their neck, that is often inconsistent. If you measure somebody's range of motion of their back and you see that they're complaining of pain and not bending very far. Then you just drag them and talk to them while they're getting dressed and you see them bend down from the floor and pick up their shoes. With that distraction, that's another red flag.