COMMENTARY: It was a three car pile up. The woman that was in front of me was completely stopped. I had stopped behind her, but the woman behind us sitting in the car hit the back of me.

DR. MICHAEL FRANCHETTI: I am trying to find out the extent of any injuries that the patient may have sustained when I do an independent medical evaluation. I am asked either by the patient’s attorney or by insurance companies to express the whole gamut of the opinions whether the accident caused the injury and question the extent of permanency of any injuries that the patient may have suffered. Does this patient still have these findings and complaints, do they need any more treatment or management.

DR. MICHAEL FRANCHETTI: If the history does not fit the examination that should raise a red flag. If the patient was complaining of numbness radiating down the arm or leg, we would expect some findings consistent with a pinched nerve whether it would be loss of strength or abnormal reflexes. If you palpate very lightly the skin over the area and the patient is wincing in pain that would be inconsistent with injury to the underlying muscles.Any pain when I do this.If you lightly press on the top of the skull, then they complained that their back hurts and they have severe pain in the neck that is often inconsistent. If you measure somebody’s range of motion of their back and you see that they are complaining of pain and not bending very far and then you distract them and then talk to them while they are getting dressed and you see them bend down from the floor to pickup their shoes with that distraction that is another red flag.