Physicians must be patients' advocates - Disability - cases of disability caused by work-related injuries - Brief Article - Statistical Data Included

USA Today (Society for the Advancement of Education), April, 2002

"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," emphasizes Mark J. Melhorn, an orthopedic surgeon with The Hand Center, Wichita, Kan.

"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 46,000,000 Americans can be labeled as disabled," Melhorn points out. "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, 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," Melhorn stresses. Prevention comes in three formats:

* Primary prevention keeps injuries and illnesses from occurring. This is the most difficult type and requires an instrument or tool to measure risk.

* Secondary prevention is the traditional health care provided by physicians. The patient (employee) develops symptoms and sees the doctor, who provides a diagnosis such as carpal tunnel syndrome and begins medical treatment.

* Tertiary prevention is designed for those 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 has been provided.

Physicians must be patient advocates and help end the antagonism between employers and employees. The treating doctor 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.

It is necessary to use the art of medicine to treat the biosocial issues, thereby decreasing the disability from the injury to assure 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," Melhorn notes. "Similarities can be drawn between sports medicine and occupational medicine. For example, examination and treatment of injury alone is not sufficient. The outcome is affected by motivation [and] 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 [and] 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."