Transcript AFP Review: Evaluation and treatment of the Acutely Injured Worker

AFP REVIEW: EVALUATION AND TREATMENT OF
THE ACUTELY INJURED WORKER
American Family Physician: January 2014
Garrett Feddersen
Article by Greg VanichKachorn, Brad Roy, Rita Lopez, and
Rebecca Sturdevant
WORKERS COMPENSATION IMPACT
In 2011, 3 million workplace injuries
 Over half required work restrictions, time off, or
job transfers
 In 2007, costs for work comp was around $50
BILLION (4x the cost of breast cancer
treatment in the US.)

FAMILY MEDICINE:
Occupational med is one of the smallest
specialties – producing 130 board-eligible
physicians annually
 Family Medicine sees around 25% of the work
comp cases in the US, nearly 3 times as many
patients as occupational medicine specialists

MOST COMMON PROFESSIONS?
1. Laborers (construction trades)
2. Nursing aides
3. Janitors/cleaners
MOST COMMON INJURIES?
1. BACK – 36%
2. Shoulder – 12%
3. Knee – 12%
JUST FOR FUN:
According to Wired Magazine
research, how much is ONE human
body worth if all of the usable parts
were sold??
Even an obese, flabby body could
be worth more than $45 million
(using cost estimates from US
hospitals and insurance companies)
Most Valuable: Bone marrow -- $23
million (based on 1,000 grams at
$23,000 per gram).
BIG CONSIDERATION!
CONSIDERATIONS
If a patient is seen by a provider not approved
by their company for a work comp injury, by
rights the employer or insurance carrier can
deny the charges.
 Employers can approve other providers
 Depends on the company and the geographical
location you are working in.

DETAILED MEDICAL HISTORY IS IMPORTANT!

First, Preexisting medical conditions can make
workers more prone to certain injuries.

Second, one of the primary goals in treating the
injured worker is to return to preinjury medical
status

Medications, alcohol, and illicit substances can
all have a roll in injury and recovery

Psychosocial factor analysis is also very
important.
MORE TRIVIA
What area of your body contains the
most sweat glands?
The soles of your feet!!
OCCUPATIONAL HISTORY
Only 28% of patients have their work history
recorded by physicians!!
 Constellation of symptoms, exposures at work,
symptoms with previous jobs
 Thorough documentation is key to employee
and employer.

RETURN TO WORK
Work participation helps maintain physical
conditioning, self-confidence, quality of life, and
function.
 Absence from work is associated with poor
outcomes: increased morbidity, financial loss,
and increased work comp costs
 It is better to have patient return to work with
limitations than prolonged absences.

RETURN TO WORK
Many physicians place unnecessary work
restrictions on injured workers to “help” the
patient.
 We need to stress the importance of work from
the beginning at the initial visit
 Pain is often part of the healing process

RETURN TO WORK
Communication is critical: employer, insurance
representatives, family members.
 Employers usually have full access to
information on work comp injuries (BUT NOT TO
THE REST OF THE MEDICAL FILE), Keep this in
mind if you are also treating this patient for
other conditions not related to the injury.

TRIVIA
How much skin does the average
person shed in a year, in pounds?
1.5 pounds!
QUICK NOTE ABOUT MEDICATIONS
Between 1999 and 2007 opioid use doubled
with work comp cases in the state of
Washington
 Opioid use associated with prolonged disability,
higher medical costs, increased risk of surgery,
and opioid addiction
 Risk of opioid use with machinery

SPECIALIZED EXAMS
Independent Medical Exam – extensive one-time
eval by a clinician or panel of clinicians not
involved in the care of the patient
 Functional Capacity Exam – usually job duty
specific, done by PT/OT
 Impairment Rating – Consensus based estimation
of percentage of anatomic, physiologic, and
psychosocial changes in function. The AMA has
published guidelines for these.
 Psych evals may also be required.

BOTTOM LINE…
DOCUMENT!
DOCUMENT!
DOCUMENT!