NOTE: This document is provided for historical purposes only.
Bradley Evanoff from HEALTH ASPECTS
MR. ALEXANDER: Our first presenter is going to be Bradley Evanoff from Washington University, talking about Health Aspects.
DR. EVANOFF: Thank you. I'd like to acknowledge the other panelists in the Health Aspects session; Dr. Rebecca Moreland from Chesapeake Occupational Health Services, and Dr. Kurt Hegman, from Medical College of Wisconsin.
Our topic was Health Aspects, also known as medical treatment programs or medical management. Although ergonomics programs should place the highest priority on prevention of injury among employees, there's still a necessity for programs to treat those employees who do become symptomatic in order to reduce impairment and disability.
There was widespread agreement among the panelists about the essential elements of a comprehensive medical management program. One is health surveillance, which has two major foci. One is to define the extent and the nature of the problem; the other is to enable early recognition and treatment of work-related musculoskeletal disorders. Many health surveillance programs will start using passive surveillance by using data that have already been collected; however, to move into a truly effective surveillance program and one which enables early recognition and treatment, it's usually necessary to do active surveillance through symptom surveys or other ways of finding symptomatic employees before they show up on your OSHA 200 log. Treating physicians also agree that the earlier you can send your employees to see us, the less you have to pay us in the long run.
An effect of surveillance programs is that if you start doing a better job counting injuries, then we typically see an initial rise in the number of reported injuries. This has been our experience at Barnes Hospital in St. Louis. As a medical management program was started, we saw a rise in our OSHA reportables initially, and this has been the experience at many other hospitals and many other employers. As you're doing a better job counting, you'll find more cases. Note, however, that there was a large drop in the number of lost days; and there was a concomitant fall in costs as well.
So if your record keeping and bonuses are based on OSHA reportables, you're going to be unhappy; but if you're looking at costs and lost days, you're going to be considerably happier. Costs and lost days are probably better measures of success than OSHA reportables.
Other elements that are important include access to appropriate health care providers. That's physicians that have specialized training and experience, a willingness to use information about job duties in diagnosis and treatment, and health care providers who are willing to use conservative treatment instead of shuffling your workers off to a "mack the knife."
Job evaluation and modification is a critical part of treating injuries that are related to job duties. If you were treating a sports injury, you couldn't think of doing that without finding out about the sport and making some modifications in the equipment, in the technique or the intensity of the sporting activity. You similarly can't treat work-related injuries without making some changes in the work that's done.
Finally, long follow-up is crucial to the success of these programs: many case management programs have been doing a good job at keeping your employees from getting lost in the specialist physician wilderness, but you can't stop follow-up at the day they return to work, because many injuries recur. Medical management efforts should also be coordinated with primary prevention, to prevent injuries in co-workers doing similar jobs.
Three important points were brought up by the audience, who participated very actively in the discussion; the first is that there is considerable controversy and confusion over many of the diagnoses of cumulative trauma disorders, particularly the role of nerve conduction studies in defining carpal tunnel syndrome. Second is that it is often difficult to differentiate work-related and non-work-related injuries. This will continue to be a problem, both for clinicians and for employers. One approach, which Dr. Hegman discussed, is that Master Lock provides accommodations both for non-work-related and work-related problems.
The overriding problem that our discussions brought to our attention is the fact that many health care providers are woefully unprepared to deal with the problems of work-related injuries; and there is a widespread feeling that there are health care providers that are not doing good service and obtaining information about work-related problems, not using information about job duties and suggesting provisions for modified duty. There were a number of people from the audience who asked us when we were going to do a better job in educating health care providers how to provide service to workers and their employers. Our reply was that employers and workers should demand medical providers who have some training specific to work-related disorders. Those of us in the academic community can provide this training, but you must help create the demand.
Thank you.
