The Compass Changes - But the Empathy Doesn't
- Dr Ash Moaveni
- Jun 9
- 2 min read
Most orthopaedic surgeons are trained to treat patients. IME work requires a different mindset.
What I wish I could tell new IMEs
I practise orthopaedics in two different settings: as a treating surgeon and as an Independent Medical Examiner. The training is the same. The mindset is different.
As a treating orthopaedic surgeon
Your starting point is simple: How do I help this person get better? You take a history, perform an examination, and order investigations. In orthopaedics this often involves imaging such as X-rays, CT scans and MRI, sometimes supplemented by specialised tests or diagnostic injections. You work through differential diagnoses and recommend treatment options.
Your compass is clear: the patient’s best interests. Your focus is on Diagnosis and Treatment.
As an Independent Medical Examiner
The mindset shifts. By the time you meet the examinee, the injury may be months or even years old. There may have been multiple specialists, treatments, and sometimes complications along the way. You rely heavily on records, which may or may not be complete. You rely on the history provided, careful observation, and examination.
Your role is not to treat. The role is to assist the court as an independent expert. Your focus usually is on Causation, Prognosis and Functional Capacity.
Yet, for most examinees, the IME process is unfamiliar. Many have never experienced one before. The detailed questions can feel unusual, and a degree of caution or defensiveness is understandable.
One thing should never change
Whether I am treating a patient or conducting an IME through my work in medicolegal assessment, one principle remains the same.
The person sitting in front of you deserves empathy.
Different roles. Different objectives.
The same obligation to treat the person in front of you with respect.
