FCE - Self limiting behavior

[SommeRiver]

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In the last 3 weeks or so I've gotten 3 pts with the following scores on self-limitation = 52%, 71%, and 82%.

One has followed up so far (71%) and I released to full duty. No rating.

The other two are coming in soon and I'm going to have to give them no rating and send them to full duty also.

How often do yall get such high scores? It is interesting bc these 3 pts are like the most disagreeable ppl of all time.

 

[clubdeac]

I've never done an FCE in 9 years in pain

 

[SommeRiver]

I've never done an FCE in 9 years in pain

I don't do them myself; I refer to my PT dept who does the exam and gives me a report.

If anyone sees WC patients at some point there's gonna be an FCE.

 

[knoxdoc]

I rarely see scores that high, but I would treat them the same way you did. I more often get the healthy 23 y/o M who is only able to lift a butter knife on an occasional basis. I warn the patient that they will have the restrictions permanently - they never care.

 

[cowboydoc]

Find out the threshold for validity on the FCE system they are using. Some are 70-75 percent, meaning 2 of the above may be valid. No rating and back to full duty for those 3 examples isn't a real nuanced approach. Consistency of effort, symptom magnification and downright faking aren't the same. It sounds like you're lumping them all together.

I find about 25% or so of my FCEs come back below threshold for consistency of effort, some of those are obvious confirmation of clinical suspicion, the borderline ones are when you have to be a physician and make some clinical judgment. I don't think that means saying they are all 100%.

 

[SommeRiver]

Find out the threshold for validity on the FCE system they are using. Some are 70-75 percent, meaning 2 of the above may be valid. No rating and back to full duty for those 3 examples isn't a real nuanced approach. Consistency of effort, symptom magnification and downright faking aren't the same. It sounds like you're lumping them all together.

I find about 25% or so of my FCEs come back below threshold for consistency of effort, some of those are obvious confirmation of clinical suspicion, the borderline ones are when you have to be a physician and make some clinical judgment. I don't think that means saying they are all 100%.

Our FCE threshold is 20% or below. In our reports the examiners list every inconsistency made by the pt, and they list a dozen or so quotes made by the pt.

These three are all getting put back to work at full duty.