Crystal balls went out with the carnies, along with tea leaves, Ouija boards, and other voodoo junk science attempting to read the minds of mankind and the future.
However, under the guise of junk science, insurance companies and others are using a questionaire to determine if claimants are "really hurt", faking, and malingering in an effort to discredit pain and suffering.
Basic fact of life is that pain is a subjective complaint. Many times common sense makes it readily apparent; othertimes it is just hard to guage the extent and severity such that the believability and verifiability rests in the credibility of the claimant.
Here is a story from the WSJ Blog entitled Test for Fingering Malingerers Comes Under Fire. Thanks to Finis Price at www.TechnoEsq.com blog for bringing this to my attention. In this story, the test went after PTSD complaints by a civilian contractor employee working in Afghanistan. Obviously, a psychiatrist and administrative law judge had no concept of the hell that can be encountered in combat AND combat support operations when you are exposed to death and dismemberment 24/7 from IED's and those who appear friendly (but are not). Stress can kill in ways not physical. I just watched a movie last night with Joseph Cotton, Ginger Rogers, and Shirley Temple, "I Will Be Seeing You" in which the shell shock or neuropsychological injuries from the soldier's side played a critical plot thread in the movie. Of course, I guess bayonet wounds and Iwo Jima are easier to accept as a basis for shell shock and emotional trauma than living under the threat of death from any number of sources all day and all night.
Here are some links on the MMPI-2™ Fake Bad Scale (FBS):
Enough of the emotional hyperbole on this topic, and a quick look at the facts. I am noting more and more insurance company doctors using what was once formerly acceptable orthopedic tests in the days before CAT scans, MRI's, EMG/NCV and other objectively verifiable tests as the basis of claims of inconsistency and malingering. For example, a straight leg raise sitting versus supine is the use of two legitimate tests which usually produce a consistent result, but not necessarily since the degree of pain and the symptoms are not always repeated.
Older othopedists and doctors from the days when a clinical diagnosis was more art than testing will know what I am talking about. Now we have "fake" tests such as a "patellar" shift of pinching the knee and asking if that hurts their back or some other part of the anatomy. Same goes for "pinching" the back.
One I have heard of is the formanal compression test of pushing down on the head which compresses the cervical spine and can cause flat out pain as well as pushing the nerves, followed by a cervical distraction test of lifting the head and relieving some of the pressure on the nerves. Some are now acting as if these tests are the keys to orthopedic malingering when once upon a time they were in the orthopedist's arsenal while forgetting the the results can be adjusted by the manner of administering the test.
Worse yet, many defense medical examiners do not consent to having the examination witnessed by a family member, nurse, or videotaped! That raises a red flag on the credibility of the tester and the results therefrom. Kentucky decisions on this topic have not been entirely favorable in a situation where the defendant insurance company get a trained interrogator with unimpeded access to a claimant without legal representation. This would never, ever occur at a deposition, but the medical profession gets a blank check.
And you can hardly blame the insurance industry when it comes to efforts at discounting pain, suffering, inconvenience and anguish (the noneconomical elements in a motor vehicle accident case; and not just "pain and suffering") when there are reported decisions in which fractured weight-bearing bones with bleeding, surgery and screws are considered to be accompanied by no pain and suffering (see, eg., http://162.114.92.72/COA/2004-CA-002226.pdf.
For example, here is a link to a text book on these tests at Special Tests for Orthopedic Examination, Third Edition. Other links of use (without any confirmation of the reliability of the site) can be found at:
Waddell signs are tests for potential non-organic causes of pain and have been around since 1980 or so. Of course, non-organic signs of pain is only a guess. I am always reminded that back in late 17th century medical doctors were bleeding George Washington with leeches as an acceptable medical practice.
If you want some scientific evidence taking issue with the Waddell signs, here is a synopsis found at the National Institute of Health search using PubMed referencing a study:
Department of Psychiatry, University of Miami School of Medicine, Miami Beach, FL, USA. d.fishbain@miami.edu
This is a structured evidence based review of all available studies addressing the concept of nonorganic findings (Waddell signs) and their potential relationship to secondary gain and malingering. The objective of this review is to determine what evidence, if any, exists for a relationship between Waddell signs and secondary gain and malingering. Waddell signs are a group of 8 physical findings divided into 5 categories, the presence of which has been alleged at times to indicate the presence of secondary gain and malingering. A computer and manual literature search produced 16 studies relating to Waddell signs and secondary gain or malingering. These references were reviewed in detail, sorted, and placed into tabular form according to topic areas, which historically have been linked with the alleged possibility of secondary gain and malingering: 1) Waddell sign correlation with worker compensation and medicolegal status; 2) Waddell sign improvement with treatment; 3) Waddell sign correlation with Minnesota Multiphasic Personality Inventory validity scores; and 4) Waddell sign correlation with physician dishonesty perception. Each report in each topic area was categorized for scientific quality according to guidelines developed by the Agency for Health Care Policy and Research. The strength and consistency of this evidence in each subject area was then also categorized according to Agency for Health Care Policy and Research guidelines. Conclusions of this review were based on these results. There was inconsistent evidence that Waddell signs were not associated with worker's compensation and medicolegal status; there was consistent evidence that Waddell signs improved with treatment; there was consistent evidence that Waddell signs were not associated with invalid paper-pencil test; and there was inconsistent evidence that Waddell signs were not associated with physician perception of effort exaggeration. Overall, 75% of these reports reported no association between Waddell signs and the 4 possible methods of identifying patients with secondary gain and/or malingering. Based on the above results, it was concluded that there was little evidence for the claims of an association between Waddell signs and secondary gain and malingering. The preponderance of the evidence points to the opposite: no association.
