BY IRENE SUVER — A medical opinion should not be a purchased commodity. It should exist outside the bounds of influence and be the distillation of the best medical information available.  Therefore, the standard for evaluation must rise to the highest medical, ethical and scientific standards, and be fair, comprehensive and defensible.

There is actually very little understanding in the non-medical community regarding the differences between medicine and surgery.   They are distinctive branches of medicine with completely different approaches. The differences extend not merely to treatment, but in every aspect of patient care, from formulating diagnoses to arriving at conclusions.  However, some specialists are acting as purveyors of limitless expertise, when in fact they have a confined scope of knowledge outside of their specific training. In the national, single examiner model, the physician has to be “all things to all people.” There is a single point of view, of training, of expertise and of belief, which results in a lack of peer challenges to the opinion and entrenched, predictable attitudes. Further the depth and breadth of expertise wanted for a legal opinion is sorely lacking.

The denigration of expert opinion in the courtroom is becoming a pointless battle of titles and publications.  So what is the best way forward?  The model that developed in Washington confines each specialist to their own area of expertise.  However, rather than a series of opinions, some of which contradict each of other and some of which do not, a “panel” of physicians, who see the patient on the same day at the same time was developed in order to create a “combined” opinion – the best expertise of several specialties, combined in a single, agreed upon conclusion.  In this way, no physician acts outside their area of expertise and no physician acts alone — but all areas of expertise are combined into a single, final assessment.  In this way, the details of evaluation are grounded in medical expertise, unassailable with a single examiner model.

Medicine is moving, inevitably, towards the practice of evidence-based medicine.  This phrase is being thrown around the community as if the definition of it is understood and agreed upon. It is not.

Warning: The vast majority of those who discuss evidence-based medicine do not have a clue what it is.  It is NOT “evidence” as it is understood by attorneys, advocates or claim managers.  It is NOT taking a conclusion or opinion and madly searching for a citation or study to back it up.

It is the conscientious, explicit and judicious use of current best evidence in arriving at conclusions.’  Conclusions in true evidence based medicine are always formulated on the basis of the best available evidence, not clinical or so-called “expert” opinion.  The purpose of evidence based medicine is not to conduct research in order to find a study or analysis that supports a preconceived or desired opinion; but rather, to formulate medical conclusions based on analysis of the best available external evidence.  Only absent valid external evidence should opinion be relied upon.  By asking questions like, “How close are the studies utilized to the questions under review?” or, “Have the studies been critically appraised?” we can gain a greater understanding of how factually correct our analyses are, and to what effect they support our claims.

Before the conference, think about these questions:

- What is fairness to you?

- What is your overall opinion of IME/second opinion physicians and providers?

- What is evidence to you?

Let me know your answers by writing them in the blog.