The fastest occupational medicine exam ever

Hi, my name’s Dr. John Alchemy—I’m a physician, a QME, as well as the CEO and founder of RateFast.

If your outpatient/office based clinic does occupational medicine, then I’d like to share a recent experience that could benefit your workplace and speed up your workday.

Using nothing but my iPhone and my laptop, I recently gave my fastest work-injury examination ever. The crazy part is that neither my patient or myself had to leave our homes.

Here’s the story: I was at home on a Saturday when I got a phone call. It was from a patient who had recently sustained a knee injury while he was at work. I had seen him recently, ordered some basic treatment, and completed a Doctor’s First report for his claim. But now he was experiencing some new symptoms: his knee was locked. He couldn’t bend it at all. Understandably, he was pretty alarmed.

If I had received this phone call 10 years ago, then my patient would have needed somebody to drive him to the emergency room, or else wait until Monday when my clinic was open. Once he got to the clinic or hospital, he would have needed to wait until somebody was available to see him. The odds of him quickly getting an appointment with me or another provider who was already familiar with his claim and work restrictions would have been pretty slim.

But that’s all in the past. Here’s what we did:

  1. We converted the phone call to a video chat.
  2. Using his phone’s camera, I examined his knee and remotely performed a physical.
  3. I determined that he had a possible bucket handle tear.
  4. While we were on the phone, I logged into RateFast on my laptop and created a PR-2 report. All the information about his injury and his employer from his Doctor’s First report imported into the PR-2 automatically, so I didn’t need to rewrite anything. Instead, I simply added some information about his new symptoms, and updated his treatment plan—specifically, I directed my patient to go to the ER or an orthopedic consultation.
  5. Then, I placed a call for sign-out to the ER. I gave them my potential diagnosis and treatment plan, which prepped them to help my patient when he arrived at the hospital.
  6. My patient’s wife drove him to the ER. But between the time they hung up the phone and the time they got into the car, I had already updated his work restrictions in RateFast and printed out the PR-2 report. It was ready to send to his employers’ insurance carrier.
  7. The whole thing—the exam, the phone call to the ER, and the PR-2 report—was over in less than 15 minutes.

Without telemedicine, this sort of visit might have easily cost my patient more than an hour—15 minutes of driving to the clinic (assuming the clinic is open), 15 minutes in the waiting room, 15 minutes of examination, and then another drive to emergency room. Without RateFast, I would’ve needed to spend extra time refreshing myself on the details of the case and filling out the PR-2 report.

Here are some of the positive outcomes of the whole business:

  1. My patient was able to get an examination without leaving his home or waiting until Monday.
  2. I essentially extended my medical practice’s office hours without losing more than few minutes of my own weekend.
  3. I was able to examine this patient without impacting the schedules of other patients who had appointments at the clinic on Monday.
  4. Since my patient didn’t need to drive as much, the employer and insurance company saved on travel expenses.
  5. My patient’s work restrictions and work status were updated sooner than they normally would’ve been, and the PR-2 was completed without a face-to-face visit.

The bottom line is that the whole claim moved forward faster, and everybody involved saved time and energy.

If you’re not already using telemedicine in your medical practice, then I can’t recommend it enough. Your patients might thank you for it.

If you’re not already on RateFast, now’s a great time to join: RateFast Express has more features than ever, and you get 2 free PR-2 and PR-4 reports (impairment ratings included!). Doctor’s First reports are completely free. Contact us at for more information about how we can help your medical practice.

Do you have all the tools you need to perform an impairment exam?

Doctors can’t calculate an accurate impairment rating without the proper tools. Here at RateFast, we’ve reviewed a lot (a lot) of impairment ratings, and in our experience, one reason why doctors produce incorrect unjustifiable ratings is because they did not take the necessary measurements.

Accurate impairment ratings require accurate measurements, and to get the right measurements, you need the right tools.

Tools to Calculate Impairment Ratings

  1. Height and weight scale and blood pressure cuff — You need basic measurements and the worker’s basic vital signs.
  2. Tape measure — Made of flexible material, like fabric.
  3. Goniometer — Used for measuring joint ranges of motion. We prefer using goniometer apps on our phones. If you have an Android phone, you can download the RateFast Simple Goniometer for free from the Google Play store. If you have an iPhone, check the Apple App Store soon!
  4. Inclinometer — An inclinometer is used to measure the spine ranges of motion. You can also use use two phone goniometers, or one digital master/slave inclinometer.
  5. Grip dynomometer — Here in California, this is only for pain-free cases, greater than one year from date of injury or surgery.
  6. Pinch dynomometer — Like the grip dynomometer, this is only for pain-free cases, greater than one year from date of injury or surgery.
  7. Monofilament set — Be sure to have a 10 gram member in the set.
  8. Two point nerve discriminator — You can use a bent paperclip measured to 6 mm distance.

That does it. Once you get these tools, you’ll be ready to gather the correct measurements for your impairment ratings like a pro.

What about the rating itself?

Of course, to actually calculate the impairment rating in California (and many other states), you’ll also need the A.M.A. Guides 5th Edition. Then, you’ll need some time to plow through all the tables, diagrams, and charts.

Alternatively, you can join RateFast, and let our impairment rating specialists calculate the rating for you.