tag:blogger.com,1999:blog-8489363879633129568.post4440833018873960246..comments2023-11-13T11:54:56.769-08:00Comments on DePaolo's World: CA WCAB Case Highlights Promotion of Needless Disability and Drug PushingAnonymoushttp://www.blogger.com/profile/02446191842560064784noreply@blogger.comBlogger1125tag:blogger.com,1999:blog-8489363879633129568.post-71515886378375066812011-11-17T13:26:42.501-08:002011-11-17T13:26:42.501-08:00You are right on target Dave. This case reflects t...You are right on target Dave. This case reflects the needless disabling that results from system design and misaligned incentives. We recognize the severity of the issue of opioids in the claims arena, however it does not appear that too few physicians recognize how they creating needless disability by poor (or biased) judgment (or lack thereof) in assigning labels and providing medications or other treatment that is not supported by evidence-based medicine - rather contributes to the disabling. Shame on any stakeholder who creates needless disability - the costs, particularly the human costs to the injured worker, are severe. Some suggestions. All participants need to be aware of the current science and factors that contribute to needless disabling. <br /><br />Two references that I highly recommend: 1) the text "AMA Guides to the Evaluation of Work Ability and Return to Work" and the article by Bob Barth, PhD on "Prescription Narcotics: An Obstacle to Maximum Medical Improvement" that appeared in the March / April 2011 Guides Newsletter. As the Editor of that AMA publication, I stated in Editors’ Commentary <br />"Pain evaluation, management, and impairment assessment are all controversial topics. The overuse of narcotic (opioid) therapy is epidemic and while it is agreed that routine use of narcotics is not recommended, there are different perspectives on whether they have a role for very select patients. This article provides excellent insights to the controversies and the problems associated with the use of narcotics, and articulates why it is medically probable that a patient taking narcotic prescriptions is not at maximal medical improvement."<br /><br />Recommend involvement of medical consultants knowledgeable about these issues and do not rely upon panel QME or AMEs that in our experience are often of poor quality and would not meet standards of "substantial evidence."Chris Brighamhttps://www.blogger.com/profile/13999919775936647395noreply@blogger.com