AFP Review: Evaluation and treatment of the Acutely Injured Worker

1. American Family Physician: January 2014 Garrett Feddersen Article by Greg VanichKachorn, Brad Roy, Rita Lopez, and Rebecca Sturdevant AFP Review: Evaluation and treatment of the Acutely Injured Worker

3. 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.) Workers compensation impact

4. 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 Family medicine:

5. 1. Laborers (construction trades) 2. Nursing aides 3. Janitors/cleaners Most common professions?

6. 1. BACK – 36% 2. Shoulder – 12% 3. Knee – 12% Most Common Injuries?

8. 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). Just for fun:

9. Big consideration!

10. 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. COnsiderations

11. 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 Detailed Medical History is Important!

12. Medications, alcohol, and illicit substances can all have a roll in injury and recovery Psychosocial factor analysis is also very important.

14. What area of your body contains the most sweat glands? The soles of your feet!! More Trivia

15. 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. Occupational History

17. 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

18. 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

19. 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. Return to work

21. How much skin does the average person shed in a year, in pounds? 1.5 pounds! Trivia

22. 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 Quick note about medications

23. 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. Specialized exams

24. DOCUMENT! DOCUMENT! DOCUMENT! Bottom line…