Arm the Worker

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Fixing the problems with the worker’s comp system is critical.  However, the system is unwieldy and we are not going to change it anytime soon.  We know extremely well what needs to happen to enable a worker to move smoothly through the system.  One of my physiatrist colleagues felt so strongly about the problems in worker’s comp that he quit practicing for a few years and became an assistant medical director of DOLI.  There were just too many barriers to enact change and he quit.

The problem is that even an ideal system will never be able to respond to the needs of a given patient quickly enough to really make a large-scale difference.  Not only are there problems navigating through all of the various parts of the worker’s comp system, these patients’ personal lives are often a disaster.  I don’t know if many of them are still even on their feet.

The more effective strategy is to give patients the tools to deal with stress.  They can often navigate their way relatively quickly through the process.  The tools also make a difference in their personal life and their families will become their support system instead of targets for their frustrations.  Conversely, without any personal support, their anger will cause them to disengage from reason and the opposite effect occurs.

It’s true that, where I practice, 80% of injured workers do well with minimal intervention.  But we don’t know which injured workers will become one of the 5% that consumes 84% of the medical resources in the state of Washington. Even the simplest injury creates additional stress on a given worker.  It is the luck of the draw whether they end up with a physician and employer that can create a smooth process.  It is unpredictable what provider or circumstance will set off the cascade of extreme disability. The idea of being pro-active in a claim is 20 years ahead of its time. It has been incredibly frustrating watching employers, in the face of overwhelming data, still not want to engage in any type of innovative process.

The category of mental health strategies described are the one’s we have been routinely using.  My concept is to “calm down” the nervous system, which has consistently decreased my patient’s perception of pain.  However, I always start with sleep.  None of the tools are effective without sleep.

I think the roundtable could develop a laundry list of strategies that could be ferreted out and implemented.  This is a group that has the power to change some things and I would challenge us to get focused.

I did become incredibly discouraged last night thinking about national politics.  Regardless of your political leanings, jobs are disappearing.  No matter how skilled you are with these stress management tools, none of them are going to negate not being able to put food on the table for yourself or your family.