Tuesday, November 8, 2011

At National - Changing the Conversation Away From Disability

Starting tomorrow the National Workers' Compensation & Disability Conference & Expo kicks off for 2 days on networking, exhibiting and education at the Las Vegas Convention Center.

This is the 20th anniversary of the conference and I have gone to most of them - particularly when it was held in Chicago ... but that's another story.

Thousands of people attend this conference and there are hundreds of exhibitors. Large entities such as big brokerage houses, insurance companies and third party administrators, to small entities such as medical equipment manufacturers, will occupy the exhibit hall plying their services or goods.

An unfortunate reality of this conference is that it is a blatant demonstration of what our conversation is about in workers' compensation.

I was a faculty member at the latest American Academy of Orthopedic Surgeons (AAOS) workers' compensation course this past weekend. My job was to pontificate on legal mumbo jumbo in language that doctors understand.

Being a faculty member also allows me to interact with really smart people - much smarter than me.

This is a group of physicians who decry unnecessary surgery and in particular back surgery where the only issue is pain without any corresponding significant objective findings. They are also very concerned with the negative ramifications of labeling people as "disabled" regardless of the percentage or temporary nature of the "disability".

Which brings me to my point - at the National Expo there are many, many vendors pitching medical services, pitching insurance services, pitching all manner of other services or goods of and concerning findings of disability. These well meaning people seek to reel business in with promises of less disability, better disability management, lower disability costs, etc.

The one common thread amongst all of these vendors, and the people that are their customers is their concern with "disability."

The conversation that circulates on the floors of the Las Vegas Convention Center is all about disability.

But maybe the conversation should be something a bit more positive. People should not be talking about "disability".

There were several presentations at the AAOS conference presenting credible scientific evidence that the mere labeling of someone as "disabled", regardless if it is in the legal or medical context, has negative implications for the injured worker, and that this labeling establishes a mind set, a self-fulfilling prophecy, that is more damaging to the injured worker than the actual consequences of the injury/illness.

A recent LinkedIn group discussion on a Georgia case where the court found a new injury when the worker was placed on alternative work that exceeded restrictions prompts this thought process. The discussion went from the legal implications of the court's holding to a discussion on maybe the "restrictions" set up the employee for the new injury by establishing a disability mindset. The established thinking was that the employer exceeded the restrictions that the physician established for the injured worker. That mindset was challenged by a physician who opined that it was not the physician's place to establish "restrictions".

I can't help but return to the lesson of James Talmage, MD, that disability is a factor of three components, one if which is completely subjective and outside anyone's scope of expertise - the injured worker's tolerance.

Really, the Georgia case analysis, if presented under this model, would be critical of the physician and the employer for not understanding the injured worker's tolerance: How much pain an individual is willing to tolerate depends on many psychosocial factors and the benefits available for doing the job.

Think about it - how many "fraud" cases are brought where the injured worker, labeled as "disabled" and unable to perform the job, is caught in surveillance performing a more pleasurable activity such as playing golf, that would otherwise belie any claim of "disability" - the tolerance for pain in a pleasurable activity, playing golf while receiving a TTD paycheck, is greater than for working at the same net pay scale.

At the National Expo Dr. Christopher Brigham will be presenting his lecture on the "Crippling of America" and how labeling people as "disabled", and treating people as "disabled", contributes to the endless cycle of non-productivity and debasement of previously healthy individuals. I think that everyone at the conference should attend this presentation.

We need to think about work injury and its consequences in a different manner, and get away from finding people "disabled". This is a cultural change, a new conversation begetting a new, more healthful viewpoint.

Perhaps the National Expo should change its name to the "National Work Injury and Recovery Conference & Expo".workers compensation, work comp, injured worker

No comments:

Post a Comment