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The newly revised Guides to the Evaluation of Permanent Impairment, sixth edition, from the American Medical Association, emphasizes the fundamental skills physicians need to evaluate and communicate patient impairments.

Standardized methodology is applied to each chapter to enhance the relevancy of impairment ratings, improve internal consistency and promote ease of application to the rating process. This ordered method enables busy physicians to become proficient with the ratings for multiple organ systems and anticipate how each chapter is organized and assimilates information.

The sixth edition applies both terminology from and an analytical framework based on the International Classification of Functioning, Disability and Health (ICF), to generate five impairment classes which permit the rating of the patient from no impairment to most severe. A diagnosis-based grid has been developed for each organ system. The grid arranges commonly used ICD-9 diagnoses within the five classes of impairment severity, according to the consensus-based dominant criterion.

Functionally based histories, physical findings and broadly accepted objective clinical test results are integrated where applicable to help physicians determine the grade within the impairment class. The result is a decision that is both transparent and reproducible.

Using the latest evidence in diagnosis and clinical tests, the new sixth edition offers the following key features:

-Standardized approach across organ systems and chapters
-Expanded use of diagnostic approach to help physicians consider relevant clinical tests and patient outcomes in performing the rating
-Required clinical information needed to rate a given condition
-Clear step-by-step grading instructions in each chapter to promote consistent scoring of impairment ratings and to improve physician consistency
-Simplified methodology presented between chapters
-Contemporary, evidence-based concepts and terminology of disablement from the ICF
-The latest scientific research and evolving medical opinion provided by nationally and internationally recognized experts
-More comprehensive and expanded diagnostic approach
-Transparent process to allow the evaluator to document functional assessment, clinical tests and physical findings
-Uniform grids to help physicians calculate impairment ratings

Average Customer Rating:

And now, the fireworks

Customer Rating:

As a physiatrist performing an average of one impairment rating a day, the 6th Edition came abruptly as a required tool. It took about 20 ratings to get into the swing of things. The big problem is the simple story of supply and reimbursement that US doctors face: It takes about twice as long to do a rating with the 6th edition in the common chapters (15,16, 17: arm, leg, spine/pelvis). Like everything else that insurance pays for, us greedy doctor types are working more and getting paid less. The book, in my estimation, is fairer, with ratings consistently decreased by about 40%.

AMA - GEPI, 6th Edition	Customer Rating:
The sixth edition of "The Guides" offers a slimmed-down version of the Fifth Edition, with sleaker looking tables and example boxes. On first glance, the differences are subtle. Certain deficiencies, such as using congenital disease in the examples, were propagated from the Fifth Edition.