*a brief intro by Pieter de Groot: My name is Pieter de Groot, CEO of Independent Medical Opinion (IMO Pty Ltd). Thank you for coming to tonight's

Transcription

1 *a brief intro by Pieter de Groot: My name is Pieter de Groot, CEO of Independent Medical Opinion (IMO Pty Ltd). Thank you for coming to tonight's seminar. * Introduce Steven Tipper, Executive Director Clinical Services, IMO Pty Ltd. who will facilitate the presentation and discussion

2 Role & objective: Facilitate discussion of the issues for medico-legal cases involving chronic fatigue syndrome and explore the role of an IME in these cases aiming to understand what is relevant in improving case management referrals. 2

3 SEMINAR OUTLINE TIMING & CONTENT 3

4 Statistics on Chronic Fatigue Syndrome Source: Chronic Fatigue. ABC Melbourne (searching for chronic fatigue across ABC Melbourne Documents: 37 fully matching) QUOTE: Chronic Fatigue Syndrome or Myalgic Encephalomyelitis: more than just tired. 17 January, :09PM AEDT.. there is currently no cure for the 180,000 Australians estimated to be suffering from Myalgic Encephalomyelitis. Chronic Fatigue: Sunrise.on7 May 4 th 2014 You Tube 250,000 Australians suffer from Chronic Fatigue Syndrome and Toby Morrison is one of the few to have recovered from it * Recent CDC estimates in the USA suggested annual costs of $51 billion dollars. [8] cited by 4

5 Fatigue after infection: aetiology and pathophysiology. Andrew R Lloyd. 4 September NOTES: ARTICLE DESCRIBES EVALUATION OF POST-INFECTIVE FATIGUE THROUGH PHYSICAL EXAMINATIONS AND LABORATORY INVESTIGATIONS. Quote: Cites: Hickie I. (2006) Post-infective and chronic fatigue syndromes precipitated by viral and non-viral pathogens: prospective cohort study. BMJ 333, CrossRef 5

6 Image & Quote: SOURCE: * WORKCOVER IMPROVEMENTS BEGIN [MEDIA RELEASE] Monday, 23 April 2012 The Hon Greg Pearce MLC, Minister for Finance and Services, Minister for the Illawarra NSW Government Media Release. Compares interstate premium rates, includes a case study on costs & outcome with an example, based on a Chronic Fatigue Syndrome case. "Chronic Fatigue" site:.worksafe.vic.gov.au [XLS] VCode tables WorkSafe 133, 941, Chronic fatigue syndrome. View shared post VCODE THE NATURE OF INJURY/ DISEASE CLASSIFICATION SYSTEM FOR VICTORIA. Version July 2008 available at data/assets/pdf_file/0010/10513/vcode_vs1.2_1_july_2008_26_june_08.pdf 6

7 Survey Highlights Serious Unmet Need for Safe & Effective Treatments May 29, The CFIDS Association of America. QUOTE: Accessed 04:45AM AEST 7

8 Refer to HANDOUT on side table (limited numbers printed but available on the References list for download) re: CFS_CDC_The-1994-Case-Definition_CDCP(webpage ) CFS_Statement of Principles_DVA_No.12 of 2014_F2014L00015.pdf 8

9 Chronic Fatigue Syndrome (CFS) Centers for Disease Control and Prevention The 1994 Case Definition. Refer References: SOURCE: A thorough medical history, physical examination, mental status examination, and laboratory tests (diagram) are recommended to identify underlying or contributing conditions that require treatment. Guidelines for the Evaluation and Study of CFS A thorough medical history, physical examination, mental status examination, and laboratory tests (diagram) are recommended to identify underlying or contributing conditions that require treatment. Diagnosis or classification cannot be made without such an evaluation. Clinically evaluated, unexplained chronic fatigue cases can be classified as CFS if the patient meets both of the following criteria: 1. The individual has severe chronic fatigue for 6 or more consecutive months that is not due to ongoing exertion or other medical conditions associated with fatigue (these other conditions need to be ruled out by a doctor after diagnostic tests have been conducted) 2. The fatigue significantly interferes with daily activities and work And [NEXT SLIDE] 9

10 The individual concurrently has four or more of the following symptoms: post-exertion malaise lasting more than 24 hours unrefreshing sleep significant impairment of short-term memory or concentration muscle pain pain in the joints without swelling or redness headaches of a new type, pattern, or severity tender lymph nodes in the neck or armpit a sore throat that is frequent or recurring These symptoms persisted or recurred during 6 or more consecutive months of illness and they cannot have first appeared before the fatigue. 10

11 IMAGE Source (accessed AEST) 11

12 READ NOTES by Dr Tim Anderson, Occupational Physician (2008) revised for 12/06/2014 IMAGE source AEST) Clinical Guides for ME/CFS and Fibromyalgia These clinical guides are suitable for both clinicians and patients, and are highly recommended, published online by Massachusetts CFIDS/ME & FM Association. 12

13 See REFERENCES for this presentation for details of articles & topical areas discussed: 13

14 Evaluation of a patient with post-infective fatigue relies on a thorough history, careful physical examination and judicious laboratory investigations. The assessment should include a review of the accuracy of the original infective diagnosis, both on clinical and epidemiological grounds, and the laboratory investigations conducted at the time. A characteristic feature of the fatigue state is a prolonged exacerbation triggered by relatively minor physical or even cognitive activities. This should be differentiated from muscle weakness (neuromuscular disease), dyspnoea (cardiac or respiratory disease), somnolence (primary sleep disorders) and loss of motivation and anhedonia (major depression). This assessment is important as a documented infection might have triggered the onset, but other factors may perpetuate the illness, such as depression or sleep wake cycle disorder 9. Cites: 9. Fukuda K. (1994) The chronic fatigue syndrome: a comprehensive approach to its definition and study. International Chronic Fatigue Syndrome Study Group. Ann. Intern. Med. 121, CrossRef 14

15 Characteristic prolonged exacerbation of fatigue is triggered by relatively minor physical or even cognitive activities. Differentiate from: muscle weakness (neuromuscular disease), dyspnoea (cardiac or respiratory disease), somnolence (primary sleep disorders) & loss of motivation and anhedonia (major depression). Fukuda K. (1994) Ann. Intern. Med. 121,

16 QUOTE: Dr Stephen Potter, Rheumatologist: OPTIONAL TO READ WHILE SLIDE ON The Lancet Review 1999 Functional Somatic Syndromes One or Many, indicating depending which specialist can be seen there can be gut features, rheumatic disease features, cardiology features, respiratory features, urology and infectious diseases features and ear, nose and throat complaints and allergy complaints. 16

17 Functional Somatic Syndromes One or Many = Google result: About 642,000 results (0.25 seconds)!!! RE: Diagnostic and Statistical Manual of Mental Disorders (DSM-5) Various scientists have argued that the DSM-5 forces clinicians to make distinctions that are not supported by solid evidence, distinctions that have major treatment implications, including drug prescriptions and the availability of health insurance coverage. General criticism of the DSM-5 ultimately resulted in a petition signed by 13,000 and sponsored by many mental health organizations, which called for outside review of the document. [1] Somatic Symptom Disorder DSM-5 better recognizes the complexity of the interface between psychiatry and medicine. Individuals with somatic symptoms plus abnormal thoughts, feelings, and behaviors may or may not have a diagnosed medical condition. Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and 17

18 Source (accessed AEST) QUOTE: IS THIS ACCEPTABLE??? We all work through pain and fatigue. You aren't special. Shut up and go be tiresome somewhere else. Read more: 18

19 Cognitive behaviour therapy for chronic fatigue syndrome. Authors' conclusions: CBT is effective in reducing the symptoms of fatigue at post-treatment compared with usual care, and may be more effective in reducing fatigue symptoms compared with other psychological therapies. The evidence base at follow-up is limited to a small group of studies with inconsistent findings. There is a lack of evidence on the comparative effectiveness of CBT alone or in combination with other treatments, and further studies are required to inform the development of effective treatment programmes for people with CFS. Price JR, Mitchell E, Tidy E, Hunot V. Cognitive behaviour therapy for chronic fatigue syndrome in adults. Cochrane Database of Systematic Reviews 2008, Issue 3. Art. No.: CD DOI: / CD pub2 Exercise for chronic fatigue syndrome [Australasian Cochrane Centre] Based on five included studies, this systematic review cautiously concludes that exercise therapy is a promising treatment for chronic fatigue syndrome. However, studies of higher quality are needed that involve different patient groups and settings Slide by Dr Tim Anderson Chronic Fatigue Nov 2008 Re-created May 2014 by Steven Tipper citing: IMAGE: UNSW Lifestyle Clinic» Services» Chronic Disease Management QUOTE: Supporting the client to better manage themselves is critical to ensure that their physical activity and lifestyle changes are sustainable long-term. 19

20 IMAGE: Source (accessed AEST): 20

21 Any questions? HANDOVER BACK TO Steven Tipper for next section 21

22 Compensable Injuries and Health Outcomes, The Royal Australasian College of Physicians, Sydney Health-Outcomes2.pdf 22

23 Peter Riddell Peter is Turks Legal, Melbourne office, Managing Partner. He is an insurance lawyer with significant experience encompassing both life and general insurance claims and products, in particular TPD, term life and income protection. Title: Partner Expertise: Insurance & Financial Services Phone: Source: 23

24 Presented by Peter Riddell, Turks Legal. REFER TO Case Summary re Whisprun Pty Ltd v Dixon_HANDOUT_final 24

25 Presented by Peter Riddell, Turks Legal. REFER TO Case Summary re Whisprun Pty Ltd v Dixon_HANDOUT_final 25

26 Presented by Peter Riddell, Turks Legal. REFER TO Case Summary re Whisprun Pty Ltd v Dixon_HANDOUT_final 26

27 In relation to the proposed questions used by me to generate discussion. I suggest the following revisions; 1. Regarding the Whinsprun case: What would you be seeking to establish and how would you run the case as Ms Dixon s & alternatively as Whisprun s legal representative? 2. Are there any questions about the diagnosis or symptoms you believe should have been asked? Why? 3. In the absence of significant medical evidence over multiple examinations, could Ms Dixon make out a case for ongoing or permanent disability? 4. If this was a Life Insurance (Income Protection) Policy claim, what legal considerations would be relevant to a claim by Ms Dixon for income protection benefits (salary continuance) or a TPD benefit? 27

28 THANK YOU to Dr John SILVER for his participation tonight [APPLAUSE] in recognition of his support & assistance in development of the CFS/ME topic material and delivery of topic in Melbourne as the Medical Specialist speaker. Dr also consults in South Hawthorn VIC, Canberra ACT, Newtown NSW. 28

29 Local Melbourne Occupational Physician in a busy clinical & research practice, who is an apology for tonight. 29

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31 Warning Message: Dr Kornan does not examine children under 15yrs. If there is a history of agression or concern for safety Dr needs to be advised. Dr also charges a fee is appointment is cancelled within 5 working days. Dr Kornan does do Skype appointments. Dr charges Late Cancellation if appointment is cancelled within 5 days. VIC Certifications S112 Approved Specialist; TAC Approved Specialist; VWA Approved Specialist; VWA Trained Assessor Permanent Impairment - AMA 4th Ed. 31

32 VIC Certifications S112 Approved Specialist Yes TAC Approved Specialist Yes VWA Approved Specialist Yes VWA Trained Assessor Permanent Impairment - AMA 4th Ed. Monash Course Yes QLD Certifications Approved Specialist Yes SA Certifications Medical Board Yes WorkCover Trained Assessor of Permanent Impairment Not Specified NSW Certifications Approved Specialist Yes 32

33 Thank you Dr Tim Anderson (APPLAUSE) in recognition of his support & assistance in development of the CFS/ME topic material and delivery of topic in Sydney as the Medical Specialist speaker. 33

34 Dr Anthony LOWY is also a regular & reliable Occupational Physician attending IMO Seminars in Sydney as an active participant. IMO has a full range of Specialists available!! 34

35 Example of a recently recruited IMO specialist : Sydney, NSW based doctor 35

36 Sydney, NSW based doctor of log-standing loyalty to Independent medical Opinion (IMO Pty Ltd) 36

37 Psychological Assessments 1. A psychologist is utilised to determine and confirm causation. That is the insurer/client would be interested in knowing whether there is any liability for the condition as a result of the reported incident. The psychologist would be able to confirm if there is any causation and describe their opinion as to how the link could be attributable to the liability of the client/insurer. 2. The individual will be examined for signs of the symptoms reported and the symptom validity test will be conducted in all cases. The results of which would be utilised by the psychologist to determined what the current capacity for work would be for the claimant and report that to the client. 3. The individual may have been in treatment for an extended period of time and there is concern regarding whether the treatment continues to be medically indicated, whether treatment will be required for an extended period into the future, whether continued treatment is related to a specific event, or whether there are any permanent disabilities as a result of the trauma. Please note, in the NSW Workers Compensation industry a psychologist is not able to undertake an assessment for the determination of WPI. Only a psychiatrist is able to do such an assessment. 37

38 Please complete the evaluation form with a note of topics you would like IMO to work up for future seminar discussion 38

39 6.00PM Pieter de Groot to close with invitation to drinks, food & networking discussion 39