Situations in which modern clinical physicians find themselves required to provide musculoskeletal impairment ratings are myriad. In fact, a practicing orthopaedic surgeon, neurosurgeon, physiatrist, or pain management physician would have to go to considerable effort to avoid other parties who wish to extract an opinion about an impairment rating. Sometimes this opinion is given in written correspondence for insurance claim adjusters or attorneys; other times it is provided in the more formal setting of deposition and courtroom testimony, with opposing counsel there more than ready to take issue if any factor seems disadvantageous to the counsel’s client.

Regardless of whether there are “interested parties” present, rendering of a medical opinion, like any other medical decision, should be done only after a careful physical examination (although in some cases review of medical records is allowed without benefit of patient examination), study of the facts, and thoughtful consideration. It is also a matter of honor, perhaps more so than some other medical decisions.

Monetary awards are made based on the medical opinion and impairment rating. It is fitting that money should compensate for injury, but one should remember that this money comes from someone else’s pocket. Every physician complains about payments for professional insurance, and no one likes to see that money paid out for claims without merit. Impairment ratings should be based on objective evidence of impairment, not subjective complaints that can be influenced by the claimant’s psyche as well as by factors of secondary gain.

My first introduction to disability evaluations, as they were called back then, was from a master of the process, a physician who took the examination every bit as seriously as his surgical procedures. If he had a case in which the individual offered considerably more unsubstantiated complaints than the average, then he would speed straight to a window that looked out onto the parking lot as the patient left. By slightly parting the curtain, he had a clear view of the patient going to his or her vehicle, and was, on occasion, rewarded by a miracle of almost biblical proportions: seeing the lame pick up his or her cane and walk unaided.