Physician Bias in WCB In Saskatchewan, there are physicians who will decide for WCB that due to lack of objective findings, the patient must be able to return to work. Case workers, without any repercussions for their actions, will also automatically terminate patients in what I call is “the shakedown” (see later). Poorly educated and overly sick subjects can be easily eliminated that way because they are in no shape to fight back. The worker’s advocate is too overloaded to respond, and lacks medical expertise to be of much help (in my opinion). Specialists will often not defend patients whose MRI is “normal”, and when they do, it can be a vague “one liner” about some evidence of cervical canal narrowing or Hyper-intense image in the disc. Interpretation however, is in essence is left to the case worker to do what s/he wants. The lack of help by some doctors and I have questioned why they do that. Some possibilities include: #1. Over-confidence in their technology and abilities #2. Health professionals do not like to admit that they do not have the knowledge/technology to know for certain what is going on. #3. Knee jerk “rule of life” that if evidence is not forthcoming, it is automatically psychological. This is a misuse of the biopsychosocial model. The model is meant to insure that all areas of life are taken into account, and to stress the interconnection between these areas. However, some insurance companies take a more ‘dualist’ approach, whereby if medical reasons are not forthcoming, claimant’s problems are automatically assumed to be psychological. #4. Being asked to make decisions by WCB at times when it is inappropriate. Generally, decisions can only validly be made on an individual when they have reached “Maximal Medical Improvement - MMI”. Often Chronic pain cases are a “work in progress” and any comments on them would be of poor quality – so reports are vague and short as possible. #5. Doctors HATE forms and are already overworked. They are also aware that the information in the forms may be ignored anyway. This was the case with one patient, where both the physiotherapist and doctor wrote that the patient was not only in no shape to return to work (also in no shape to even do an FCE) - but case worker on basis of an off remark from a WCB reviewer who said subject should be “boarded” decided to terminate coverage. #6. But there is a more serious issue that generates considerable problem. The chronic pain patient has been trivialized, unbelieved, had his benefits and future threatened, told that it is his fault he has this problems (nuts, too deconditioned and so on) by people they know do not necessarily have their best interests at heart. - in short victimized to the point that he will go out of his way to be at least taken a bit seriously. I call this “desperation” to be taken seriously while others have called it “Pain Behavior” Bigos et al. Bigos SJ, Baker R, Lee S: A definition and approach to helping the patient with a return to work predicament. Phys Med Rehabil Clin North Am 1993, 4:109–123. “Pain behavior is but a higher level of the behavioral changes observed in a threatened animal. These patients feel “trapped” without options in a system in which everyone seems to be trying to force them to face failure... pain behavior that continues at a high level after 4 to 6 weeks of care probably indicates that the patient is not convinced that we truly have his or her best interest in mind.” Feldman(1998) puts it very well: System Factors The effects of industrial compensation systems on the work-injured patient comprise another major theme in the literature. It is an adversarial system designed to provide “care” for patients, with negative attitudes concerning injured workers prevalent among insurance providers and, all too often, professional caregivers. Bigos et al. [2], citing the work of Guest and Drummond [24], have most thoroughly and persuasively argued that this system is inherently harmful to individuals trapped within it: The creation of the term industrial back pain apparently fostered the development of adversarial attitudes and expensive systems that have only worsened the burden by expanding costs without returning the injured worker to productivity. “Adversarial help” seems, and mostly is, a contradiction in terms. In any event, this “adversarial help” system, although a growing expense, has had little effect in aiding the worker or society by reaching the goal of keeping our populous productive until retirement age. Individuals often focus on their pain in an effort to legitimize their injury and themselves when under the stress of facing an adversarial system in which employers, insurance case managers, and health professionals often view them as malingerers. Patients tend to express their emotional stress and the frustration of feeling trapped via what is generally termed pain behavior. They are attempting to communicate: _____________________________________________ CBI Physiotherapy did not think the injured worker was recoverable:
Posted on: Tue, 13 Jan 2015 20:54:11 +0000
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