It’s Complicated – The Importance of Choices

It’s Complicated – The Importance of Choices



Last week’s comments illustrated the substantial difference doctors’ choices can make when it comes to workers’ compensation.

This point was also raised in a presentation at the recent IAIABC forum. Dr. James Talmage, a well-known authority on workers’ compensation medical care, spoke about “Working with Physicians to Ensure Return to Work.” His speech included some of the complexities of medical care that plague workers’ compensation. He also called for careful screening and building relationships with doctors who provide care to injured employees.

A surprising point Dr. Talmage made was that misdiagnosis can result from physicians’ overreliance on MRIs, a favorite target of utilization reviewers. Without considering that aging causes a symptomless body to deteriorate, pain complaints can be misinterpreted as being caused by a new injury instead of changes due to normal aging.

This point was raised in a study of a group of 294 employees who worked for an opt-out employer in Texas and who filed claims for shoulder or knee injuries. In the study, MRI scans were performed on employees’ shoulders or knees, depending on their complaints of pain. More than half of the employees had more physical abnormalities on the asymptomatic side than on the symptomatic side. The study is available here.

Dr. Talmage pointed out that this reliance on MRI scans is understandable. When doctors were medical students, they equated the objective results of an MRI with evidence of an injury. This reasoning would make sense in cases where a person has a persistent cough and the CT scan shows lung cancer. The medical student could safely conclude that the cough was caused by cancer.

So if an MRI on the symptomatic knee or shoulder showed an abnormality, it would make sense for the doctor to suspect knee pathology unless they did an MRI of both knees or shoulders and found that the symptomatic knee or shoulder showed fewer abnormalities. than the asymptomatic knee. In these cases, the doctor should determine if the problem was related to aging rather than a specific incident.

This demonstrates the importance of selecting physicians who understand the possible sources of symptoms, so they can provide the appropriate medical treatment.

When selecting physicians, a critical decision is choosing a physician who approaches a workers’ compensation patient differently than a group health patient. Doctors are used to using the biomedical model which only considers anatomy and physiology? but outcomes can be improved by using a biopsychosocial model that includes an understanding of a patient’s comorbidities, job satisfaction, quality of family life, history of opioid use, adverse events during treatment. childhood and the patient’s understanding or misunderstanding of workers’ compensation. Consideration of all of these factors will help the physician guide the patient towards recovery and return to normal life and work in their particular situation.

The importance of focusing on recovery from the first encounter with a patient until they are successfully and safely returned to work cannot be overemphasized. As Dr. Mark Melhorn, editor of the AMA’s guides to the causes of illness and injury, has said, “Physicians must practice effective and empathetic communication strategies to help injured workers understand the benefits of an early return to work”.

These are two of many examples of the importance of the choice of physician in treating injured employees. Employers can make a difference in workers’ compensation systems by using physicians who understand the unique considerations of workplace patients.

To help employers find the right doctor for their workers’ compensation programs, the State of Tennessee has developed a toolkit that includes information on how to select and build effective relationships with doctors. . The toolkit contains sections on how to choose the right Panel Physician, including:

  • The information that the employer must provide to the attending physician,
  • Advice to facilitate an effective flow of information between the employer and the doctor,
  • A list of transitional jobs available for takeover employees,
  • Sample job descriptions/analysis written to provide the specific information a doctor needs, and
  • Sample transition work letters that can be used when the employee is able to return to work within restrictions.

The toolkit is exactly what one state did, but there are 49 other states and countless employers who have been proactive in providing the medical care that gives injured employees the best chance of recovery.

This blog is here to provide a forum where cutting-edge ideas can be shared. Will you share yours?




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