Monday, March 4, 2013

A Word That's Both Noun and Adjective

One of the comments left in a lengthy thread in the WorkCompCentral LinkedIn group noted:

"I have always found it interesting that we call them injured workers, claimants etc, but we hardly call them patients. Yet, that is what they are, patients."

This struck me as particularly poignant, since the thread was all about the difficulties that vendors, in particular medical vendors, have had getting paid since the passage of SB 863 in California with the bill's imposition of filing and activation fees for liens, whether on a lien basis on as part of an approved Medical Provider Network.

The focus of the thread centered on the inability of these medical vendors to provide care to ... ahem, patients ... where either injury AOE/COE is denied for some reason, or a claimed body part is denied, etc.

The term "patient" is peculiar to the provision of medical services. defines the noun usage of the word as "a person who is under medical care or treatment."

"Patient" seems to me to be a more personal reference to the person who was injured on the job.

Perhaps because the term "patient" is more personal is the reason why it is avoided in workers' compensation discussions - for if those providing services, be it adjuster, attorney, physician - actually had to acknowledge the beneficiary of these services and benefits as a human being it would be more difficult to deny care or indemnity.

"Injured worker" obviously is an accurate term, because if the human being that has been assigned a claim number was not making an assertion of injury at work, then there would be no workers' compensation filing.

And "claimant" likewise is an accurate term because the human behind the Initial Report of Injury is making a claim to entitlement of benefits.

Yet, in the medical world this person is a "patient" - at least for treatment purposes.

Medical-legal physicians prefer not to call the subjects of their reports "patients" because the term implies some relationship deeper than just an evaluation - the term "patient" connotes a relationship whereby the physician has a duty to do no harm, to provide relief in a medical context. A physician writing a report describing a condition for purposes of benefit determination doesn't have the same relationship as a physician making a prescription for treatment.

I understand this dehumanization as I often use the terms "injured worker" or "claimant." It provides some level of objectivity, impersonalization. Without this buffer our jobs as professionals in workers' compensation would become much more difficult because we too are human beings with subjective feelings and emotions that color our reality, color our world. "Claimant," "injured worker" and other terms serve to help us cope with the more difficult aspects of our jobs.

Sometimes, though, I think we allow this dehumanization to degrade our senses too much, too often, and we get into a base level of mental operation that fails us at the most critical of moments.

I look at the processes that have been invented to manage the system - the rules, the time limits, the forms - and as I've mentioned before, am amazed at how complex and seemingly illogical many of these are in relation to the day to day delivery of care and benefits.

The system itself seems to have lost the notion that there are people behind these claims, folks who have little to no understanding of the rules of engagement they have been foisted into.

To highlight, at the Division of Workers' Compensation Educational Conference in Los Angeles last week a presentation by members of the Audit Unit let the audience know that a concerted effort was going on to reduce the number of, and complexity of, required forms that are involved in claims processing.

This is good. In my opinion not only has the statutory law and regulatory environment of workers' compensation in California (and many other states) attained an unprecedented level of aggravating complexity, but the forms and other associated information intake and output are likewise confusing and intimidating.

I think a lot of people want to do the "right" thing, but when someone gets a notice which warns that one's rights may be affected in big bold print, while at the same time admonishing that one need not hire a lawyer ... who are you going to trust? The state and its complex, voluminous forms with threatening legalese, or the guy across the desk from you wearing a tie and a few diplomas behind him that can explain this mess in simple understandable terms?

When used as an adjective defines "patient" as "bearing provocation, annoyance, misfortune, delay, hardship, pain, etc., with fortitude and calm and without complaint, anger, or the like."

For those who are the subject of the workers' compensation system now, they are both patients and patient.

There's a lesson in a word that is both a noun and an adjective.

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