Wednesday, Oct. 17, 2001
For more information, contact:Joanne L. Swanson(847) 384-4035 [email protected]
A.J. Wright(847) 384-4034 [email protected]
Todd Schuetz(847) 384-4032 [email protected]
PHYSICIANS MUST BE PATIENT'S ADVOCATE ON BACK-TO-WORK ISSUES
NEW YORK-"Everyone loses when workers are injured or disabled for long periods of time. The insurer, employer and society suffer the economic losses, while the employee suffers the individual loss from time off work, decreased income and costly medical bills. For the employee, a bilateral carpal tunnel syndrome surgery can cost as much as $75,000 in direct and indirect costs.
The opportunity to change the current lose-lose situation to win-win lies in prompt treatment and early return to work," stated Mark J. Melhorn, orthopaedic surgeon, of The Hand Center, Wichita, Kansas, speaking at the American Academy of Orthopaedic Surgeons Orthopaedics Update conference.
Unnecessary loss of work is costly for the individual, employer, and society. Past estimates were $177 billion or approximately 6.5% of the gross domestic product when the cost of exclusion from the workplace, medical care, legal services, and earning replacements are summed. The jury is still out on the loss of work costs for recent years.
"Obviously, disability management represents an area of medicine that has large financial impact upon society. Depending upon one's definition of disability, between 35 and 46 million Americans can be labeled as disabled," said Dr. Melhorn.
The definition of disability and the determination of who is disabled continue to challenge governments and adjudicating bodies. Thus, the definitions of disability expands and contracts more along political and ideological lines than according to any clear physical determinations."
Occupational health incorporates the concepts of ergonomics, back-to-work (return to work), and medical management of disability. "In occupational medicine, it is not only necessary to fix the worker; one must have an idea about how to improve the workplace to prevent future injury," said Dr. Melhorn. Prevention comes in three formats:
1. Primary prevention keeps injuries and illnesses from occurring. This is the most difficult type of prevention and requires an instrument or tool to measure risk.
2. Secondary prevention is the traditional healthcare provided by physicians. The patient (employee) develops symptoms and sees the physician, who provides a diagnosis such as carpal tunnel syndrome, and begins medical treatment.
3. Tertiary prevention is designed for injuries that have reached advanced stages and threaten to produce significant side effects of complications. Most workplace injuries do not reach this level because early medical treatment is provided.
Ergonomics is the study of relationships of man to machines based on engineering, biomechanics, physiology, anthropology, and psychology. Ergonomic intervention is the process of developing a good fit between the individual and tool, while improving comfort, health, efficiency, and productivity of work.
Physicians must be the patient advocate and help end the antagonism between employers and employees. The treating physician can improve the quality of life for the injured worker by using the science of medicine to treat the anatomical injury; thereby decreasing the physical impairment.
And using the art of medicine, to treat the biosocial issues, thereby decreasing the disability from the injury is less handicap for the individual and improved treatment outcomes at a lower financial cost. "This approach provides treating physicians with a unique opportunity and obligation to provide reasonable work guides in an effort to reduce work disability, improve the outcome for work related injuries, and advance the quality of life for their patients," stated Dr. Melhorn. "Similarities can be drawn between sports medicine and occupational medicine. For example, examination and treatment of the injury alone is not sufficient."
Dr. Melhorn goes on to say, "The outcome is affected by motivation, social, psychological, economic, and community values. After recovery, an injured player is expected to return to the game and perform at his or her previous level of athletic ability. Similarly, the injured industrial worker is expected to return to his or her previous level of performance, accomplish a particular task within a reasonable time frame.
As in sports medicine, the management and prevention of workplace injury demand a dedicated and knowledgeable cadre of physicians, surgeons, and therapists who are able to apply modern knowledge and expertise to a successful medical program. In both sports medicine and occupational medicine, prevention is the best approach."
The 25,5000 member American Academy of Orthopaedic Surgeons (www.aaos.org) or (http://orthoinfo.aaos.org), is a not-for-profit organization that provides education programs for orthopaedic surgeons, allied health professionals and the public.
An advocate for improved patient care, the Academy is participating in the Bone and Joint Decade (www.boneandjointdecade.org), the global initiative in the years 2000-2010 to raise awareness of musculoskeletal health, stimulate research and improve people's quality of life.
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