Articles from prior issues of The Advocate

July/August 2001

Consultative Examinations - Experiences of James Read, Ph.D.
by Ken Forbes, Oregon DDS

WHILE MY NORMAL REPORT OF a presentation does not include this sort of information, it is important to your understanding of this presenter’s activities. Dr. Read is a tall man, easily six feet eight inches tall. He is an avid bicyclist, riding thirty miles before coming to make the presentation to us. Though he didn’t tell this until the end of his presentation, I think this might also help set the stage. Dr. Read was once invited to spend some time with Patch Adams and company. Ironically, Dr. Read felt he had been invited to bring an appearance of normalcy to the staff.

So, how does he do his work?

He generally takes 75-90 minutes for a mental status examination. He said his examination begins before the claimant enters the examination room and continues after the claimant leaves. He watches out the window as they arrive and after they finish in order to gain perspective regarding the physical complaints that may be discussed during the examination itself.

Just like everyone else, Dr. Read does a face-to-face interview. With permission of the claimant, he includes a spouse or significant other that comes to the examination. In fact, he includes collateral observations from these people that accompany the claimant to the examination. He uses a Five Axis (“multiaxial”) Diagnostic tool as described below:

Axis 1 - Clinical disorders (other disorders that may be a focus of clinical attention)

Axis 2 - Personality disorders, mental retardation

Axis 3 - General Medical conditions

Axis 4 - Psychosocial and Environmental Problems

Axis 5 - Global assessment of functioning

When asked to assess malingering he watches for inconsistencies or congruence between behaviors and claimed conditions. “This is very difficult,” he admits. He also listens for over endorsement of symptoms, bad sign too! Test results may help (Qualitative observations are important). A negative or hostile attitude does NOT necessarily mean malingering. Substance abuse and “Dual Diagnosis” are challenging because it is so hard to separate the cart from the horse and determine which precedes the other impairment. The patient's history is vital in sorting out the "Dual Diagnosis." ADHD is difficult to diagnosis and is often OVER diagnosed while Bipolar Disorder is often misdiagnosed after a five-minute mini history taking! He shared a few entertaining examples of claimants he has seen. The most colorful was the Intoxicated “biker” who arrived in full leathers and chains! The scariest was a 16 year old wild girl! This was the only patient he saw in the office in which the police visited. (Someone else called them.)

His most embarrassing moment was the chronic pain patient with PTSD the doctor believed completely, until he viewed a videotape brought in by attorneys!

The most blatant claimant was the Glaucoma patient who claimed his disability was glaucoma and that he couldn’t drive - but in the parking lot the patient got into the driver’s side of the car. He was threatened by a sports car driver, who threatened both the doctor and the adjudicator. He claimed he was crippled up and went through the interview bent over, limping and carrying on, but he was able to walk to his car and jump in after the interview. The worst behaved claimant was a young boy who required a SWAT team from health and welfare to remove him from the office. His most unusual examination was a mental status done for a homeless man - it occurred in Dr. Read’s car.

Dr. Read believes children who really need help are often the most “prickly” and he said “I have failed with all of them.” He certainly did not fail with us as each of us took away a great deal more knowledge than we came in with!