Many U.S. companies are transplanting their plants abroad so as not to deal with the problem under the current rules governing the system.
The traditional methods of treating the employee, whether considering mainstream medicine, chiropractic, or physical therapy as primary portals of entry into the system, have not worked, are not working, nor will they work as a successful means of curtailing the compensation claims process.
Let's begin our discussion by reviewing the three major components causing the production and costs of a workers' compensation case: (1) quality of the management/employee relationship; (2) the physical demands required of the job tasks involved in producing the product and/or service; (3) the quality and effectiveness of the medical intervention involving the particular injury or illness.
While the first two factors relate to the quantity of claims produced, the third component is directly responsible for the overall cost of the claim. These factors are not the same as an injury and should be clearly understood as being something different. A good example would be examining two individuals with the same diagnosis of tennis elbow. The first worker has the feeling that the company cares about him and has a feeling of commitment and trust about the company. The other worker voices a strong opinion that the company does not care about his well-being and cannot be trusted. I think most everyone would agree there would be two very different costs in dollars and time and productivity associated with these people, yet the "injury" (actually illness is the correct term as CTD is placed under that category in the OSHA 200 log) is the same in both cases.
The doctor's part in this process is at best a compromising situation most of the time. Many times the individual with the complaint does not say anything about it or is put off from seeing a physician until reaching an acute phase of the cumulative trauma disorder. The symptomatology has reached a point where the worker cannot perform the required job task, and/or has symptoms that are frightening to the worker and the company as well. This usually results in an appointment made that "needs to be seen right away." If the doctor's office cannot accommodate this strategy, another certainly will. This generally means that the office schedule is backed up, the worker waits longer than normal, routine patients are hurried or begin a wait that will last the rest of the afternoon.
In many areas, especially smaller cities, the doctor may treat other members of the family, and certainly other co-workers. Here is what happens on the typical workers' compensation visit: injured employee waits 30 minutes to see the doctor (many times on his own time). The doctor finally rushes in and meets the employee. Whether this person is a previous patient or new to the office, the doctor has to make several decisions.
Let's look at the doctor's thought process (aside from the clinical diagnosis) as it relates to dealing with the person and the company. The employee says, "My hands are numb." The doctor is already in the trap because the employee is saying he can't work. A decision such as, "Yes you can go back to work on normal duty" (with whatever treatment regimen selected), will make the worker mad, or distrustful. He will probably be vocal about it to co-workers and relatives. In today's health care marketplace, any doctor hates to alienate patients, but the doctor also knows that if he scripts a restriction from duty, the company responds with finding someone who will work a little better on the time loss with the company.
So the doctor reviews his options and chooses a light duty restriction that he thinks will compromise both the patient and the company. At this point the doctor loses either way -- the company and the patient. Please remember, this is the typical soft tissue injury so frustrating to the worker, company, and the physician. The doctor has compromised between regular duty and total restricted duty -- the infamous "light duty" restriction. The next reasonable question to the employee or the company-contact person is, "What can the person do?" The answer will vary depending whom is asked, which is why it is a losing proposition.
In this way, the doctor becomes one of the many co-defendants of the dysfunctional work force. (I will discuss others in future articles.) Also, please note that this decision is seen as subjective and emotional by both the company and the employee, and when this approach fails (as it almost always does), the doctor is blamed by both the company and the employee. It is important to remember that it doesn't matter whether the individual follows chiropractic care, physical therapy, or the traditional splint/anti-inflammatory/rest approach. It is the "light duty" restriction that accompanies the treatment that we are discussing.
We know that manipulation can be a very effective approach if not diluted by external problems, but that is not an issue here, as the "light duty" restriction will actually cause any conservative treatment regimen to fail. This is important because the patient's confidence has been shaken and opens the door for others to lay the blame on manipulation.
Let us see how restricted duty effects the three main factors in the compensation claims process.
- Management/employee relationship (including employee/employee relationship). Co-workers do not mind helping out for a short time, but as the "light duty mind set" continues, they resent having to work harder to make up the difference. This causes friction with all concerned, from supervisors to human resource managers.
- Physical demand is increased for those workers who remain on regular duty. The difficult jobs that require more effort and repetition than less strenuous jobs must have "light duty" job tasks for recovery time in a good rotation sequence. Without this rest, the physical demand just elevates. As a side note, prolonged light duty positions may take on permanent descriptions under the reasonable accommodation aspects of the American Disabilities Act of 1992.
- Medical intervention is being undermined by factors such as symptom magnification and learned behaviors consistent with a dysfunctional work force and/or worker. Treatment becomes prolonged, loses effectiveness, and the worker becomes dependent on it. This is especially bad for the approach of ongoing chiropractic treatment without any conclusion other than the patient still hurts. When treatment finally is terminated, the worker will still complain and the chiropractic care is deemed less than effective. This is true for all types of treatment, not just chiropractic. If you, as a chiropractic physician, are basing the bulk of your relationship on treatment, it may end very abruptly if certain "details" are not attended to.
There is a workable solution to this dilemma of subjective-based work restrictions. In plants that I work with, the doctors are objectively able to send the worker back to the job by evaluating the essential job function parameters. This decision is held in agreement by the employee and company alike, without the blame for something gone wrong coming back to the initial treating physician.
Theodore Oslay, DC
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