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Disability revisited.

Am Fam Phys 2003 Jul; 68(1):175-180
Case Scenario: I have a patient who had major abdominal surgery a few years ago for a fulminant illness. Not long ago, on his first visit to my office, he handed me a disability form. He said that he had chronic pain and that I needed to get this form filled out quickly because he had no money to live on. My student and I smelled alcohol on the patient's breath. I could not determine from the operative report or other records whether alcohol played a role in his illness nor do the records indicate why he might still be in pain. Pain could be a consequence of the surgery, but I did not think that it was up to me to decide whether his pain was debilitating. The fact that he had been drinking certainly diminished his credibility with me, even though he insisted that he drank only rarely. I explained to him that as a physician, I could only report on his medical condition. I filled out the disability form as well as I could, summarizing his surgery, stating that the patient complained of ongoing pain, and indicating that I was unable to determine whether this was a condition that could result in permanent disability. At his next visit, the patient presented me with another blank disability form. He also showed me a letter from the agency, which stated that the claim was not denied, but that more evidence was needed to prove he was disabled. He gave me the blank form to complete. Having already provided the facts to the best of my ability, what additional information was being requested? Was I being expected to steer the interpretation of the medical condition in a particular direction? As it happened, subsequent labwork showed abnormalities that allowed me to offer a diagnosis, even if it was an unlikely cause of the actual pain. I have been told that physicians should just state the facts about our patients, and that someone else will make the disability decisions. Is that correct?
Disabled-workers; Pain-tolerance; Physicians; Medical-care; Medical-services; Surgery; Case-studies
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American Family Physician
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University of Utah, Salt Lake City, Utah