Monthly Archives: August 2015

August 14, 2015

Interview with Praxis Partners founding member: Chris Brigham, MD

From time to time I will be interviewing members of the Praxis Partners Consortium, and encouraging them to tell us what they are up to. This first interview is with one of the founders of Praxis, Christopher Brigham, MD.  He is an internationally recognized thought leader on human potential, impairment, and disability. More biographical information appears below the interview.

ChrisBrighamHead-Compressed

JC:  Please begin by telling us, Dr. Brigham, why you decided to join the group that founded the Praxis Partners Consortium?
There appears to be an underlying philosophy that we share.  Contemporary society needlessly traps so many into being injured and ill, and ultimately to being disabled.  Our health care and disability “systems” are broken and badly in need of repair – ultimately resulting in poor health outcomes and needless disability. We have fragmented components that often focus on what is most beneficial for the providers and others in the industry, rather the individual.  Incentives, perceptions and motivations often make all the difference in our health and in our lives. Societally-defined “disability” often fails to recognize the dynamics of human potential and the benefits of an active life.  Each day countless individuals experience needless disability and poor health outcomes that are preventable. As a nation, employers, and insurers we confront ever-increasing costs. This is a tragedy for each of us, our families and our society.  The United States leads the world in health care costs, however we are not healthier nor do we live longer.  We need to share this information widely.  It is together that we will create change, starting by creating awareness.

JC:  Can you tell us a bit about the book that you and Henry Bennett recently published entitled Living Abled & Healthy: Your Guide to Injury & Illness Recovery.
Living Abled & Healthy is a guide for all of us on taking charge during injury or illness rather than allowing others to take charge of us. It is linked with a website, www.livingabled.com, which provides web-based resources.

JC: What inspired you to write Living Abled & Healthy?
For over three decades, as a clinician and as a researcher focusing on health and disability issues, I have pondered:
• Why do people with similar problems, even when they receive the same care, sometimes have dramatically different outcomes?
• What defines disability and how may it be prevented?
• How do compensation systems, healthcare professionals, and our own actions contribute to our health or disability?
• How are we best able to experience joyful and productive lives?

I had encountered too many people who were experiencing needlessly diminished lives, while at the same time I was inspired by others who were living exceptional lives despite significant injury and illness.  I have also been appalled by others who misuse trusting individuals for personal financial gain.  I realized I could have more impact by writing and sharing my insights with others, and my co-author Henry Bennett supported me in making that possible.

JC:  Can you share some tips from your book on how to recover from injury or illness?
Here are ten core principles that we have found most helpful in recovering from injury or illness
1. Taking control of our life and health
We all need to take and keep control of our lives, including our health. When we have a health challenge, we need to identify our best resources and then take action. No one else may be allowed to dictate our lives. Our moments of doubt must not be exploited by others.

2. Staying positive
A positive attitude helps us to focus on our strengths, understand but ignore our weaknesses, and move on with our lives. When we change our thinking and our beliefs, we change our lives.

3. Partnering with quality healthcare providers practicing evidence-based and data-driven medicine
When doctors offer us a conclusion or recommendation—whether about our diagnosis, what caused our problem, or ordering tests or treatments—we want to believe they have solid reasons. We want our medical care to be based on the best available evidence, identified by scientific method, for clinical decision-making. This process is known as “evidence-based medicine.”

4. Approaching health problems from a “biopsychosocial” perspective
To better understand injury, illness, and disability, we embrace a “biopsychosocial” approach including biological, psychological, and social elements. Physical illnesses affect all of who we are—including our minds and spirits. Our mind-body connections are surprisingly strong. Physical, social, and work environments all affect health.

5. Weighing the risks and benefits of testing and treatment
All testing and treatment is associated with risks and possible benefits. We need to discern what is best for us. When doctors recommend testing or treatment we need to ask what the risks and benefits may be.

6.Focusing on a healthy body, mind, and spirit
Health encompasses our bodies, minds and spirits—they all relate. What goes on in our minds—attitudes, beliefs, perceptions, and resiliency—significantly affects what happens in our bodies. Thoughts affect bodies at least as much as bodies affect thoughts. Maintaining a strong spirit gives us purpose. Mastering these concepts helps us master our lives.

7. Choosing smart lifestyles including exercise, diet, and health habits
We can eat right, stay physically fit, maintain an appropriate weight, do our best to sleep well, not smoke, and not abuse alcohol and/or other drugs. Our choices are important factors in whether or not we stay healthy. We need to be honest with ourselves. We can make healthy choices.

8. Weighing the risks and benefits of involving lawyers
Sometimes we need the assistance of lawyers, other times we do not. Involvement with lawyers may complicate our lives and result in poorer outcomes—for us. If our situation requires a lawyer, we need to discern how to select the best lawyer and make sure they are working for us.

9. Cooperating with other healthcare participants and avoiding unnecessary conflict
We should choose our healthcare participants wisely and then maximize the value we obtain from them. This requires careful planning.

10. Continuing with our jobs, if at all possible
Work is, in general, good for our health and well-being. Our work often helps us to establish who we are, our identities, and our status. Work provides structure and gives us a reason—a need—to get up daily. Not working places us at greater risk of poorer physical and mental health, long-standing illnesses, psychological distress, increased use of healthcare resources, and death.

Where can people get more information?
At the website of www.livingabled.com  and the book is available on Amazon, among many other sources.

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Biographical information.  Chris Brigham received a Masters of Medical Science from Rutgers Medical School, an MD from Washington University in St. Louis and did post-graduate training at the Eastern Maine Medical Center in Bangor, Maine. He is board-certified in occupational medicine, highly credentialed, has edited and co-authored several books, and written over two hundred peer-reviewed articles. He is the Editor of the AMA Guides Newsletter and Senior Contributing Editor for the AMA Guides to the Evaluation of Permanent Impairment, Sixth Edition. He is committed to working with others in the application of evidence-based medicine and best practices to promote function and avoid needless disability.  Dr. Brigham is also an accomplished professional speaker. He is passionate about creating change that will:
•    empower individuals to live productive lives and
•    reduce human and financial costs associated with disabling.

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August 12, 2015

Who will address working people’s reasonable concerns when illness or injury disrupt their lives?

What do working people wonder and worry about when their lives (and work) have just been disrupted by a new illness, injury, or a change in a chronic condition?

While creating a course to train doctors how to meet their patient’s needs, we realized we had to know what those needs were.  It seemed obvious that patients would want to know what is wrong with them and what kind of medical care they need.  But beyond those things, we came up with a list of predictable and totally reasonable issues:

How long am I going to be laid up (out of commission)?
How long do I have to take it easy?
When I can go back to doing my usual stuff?
In the meanwhile, what can I still do? What shouldn’t I do?
What can I do to speed my recovery?
If I can’t work, how will we pay our bills next month?
When will life be back to normal? …..if ever?
What does this mean about me?   My future?
What is this going to do to my livelihood?  What will this do to us financially?
Who will help me?  Who can I trust?  Who has my best interests at heart?

I often show this list when I am speaking to groups about how to improve outcomes for people with common health conditions like back pain.  It always rings true with the audience.  After one presentation, an influential executive (in a wheelchair with quadriplegia) told me that she had had all of those concerns immediately upon awakening after her accident.

Here’s my question:   How are people getting these questions and concerns answered — when and by whom?  The standard design of a medical visit (memorized by all physicians during our medical training) DOES NOT include a time for doing it.  There is no sub-heading in our report format called:  Patient Education,  Instruction, and Guidance.  If it is happening, it is spotty at best.

So if most doctors are not answering these questions, who is?   Which of the other professionals who are responsible for responding to life & work disruption in working people IS going to address them?   Unless one of these “experts” does so, the people will have to come up with their own answers.  Yet how many are prepared to do that?   They will come up with their own best guesses (which may be wacky) or may turn to their family, friends, co-worker, neighbor, union steward, or a lawyer for answers (who may or may not give them a bum steer).

What does this mean for you?  If you are committed to better service (and/or want to avoid the trouble caused by bad advice), figure out a way to meet people’s totally reasonable needs for information and advice.   If you are a treating clinician, consider making a revision to your standard visit protocol and report templates by adding that missing section:  Patient Education, Instruction & Guidance.

Another simple idea for healthcare providers, employers or insurers is to create a standard operating procedure to mail out or hand out a brochure.  The 60 Summits Project developed a fact sheet for employees whose health conditions have just started to disrupt their work — and a fact sheet for supervisors on how to manage the situation in the workplace..  Feel free to use these sheets as is, or remove the 60 Summits logo and revise them to suit yourself.  But please do SOMETHING!

 

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August 7, 2015

Who should be accountable for NEEDLESS job loss due to medical conditions?

Who do you think should be held accountable when workers needlessly lose their jobs because a newly-acquired or changed health condition or disability?

Right now, none of the professional participants who play front-line roles in the stay-at-work/return-to-work process feels a responsibility to prevent unnecessary job loss.  Doctors, employers, insurance companies, lawyers and so on simply think it’s a shame when it happens — if they are even aware of it.  Unnecessary job loss is being viewed as a private tragedy rather than a sentinel indicator of service and system failure.  A lot more sunshine is needed to illuminate this dark corner.

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Even though OSHA ensures that employers record the number of work-related injuries, lost work-days and deaths, there is no requirement that they record job loss.  Why isn’t it being tracked?   It will almost always be a much worse consequence than the injury itself.   Job loss, especially in someone who was previously healthy but now has some degree of impairment, can be DEVASTATING.   Few people are prepared to deal with this double- barreled challenge.   For the unlucky ones, this means losing their footing in the world of work forever.

We do not even KNOW how many people lose their jobs as the result of work-related injuries much less personal health conditions — and how many fail to find new jobs. I personally don’t think it matters what the cause of the health condition is.

These days, more than a HALF of the people entering the Social Security Disability Insurance program are doing so because of adverse secondary consequences of common health conditions like back pain, joint pain, anxiety, and depression.  But notice this:  there are literally MILLIONS of people who keep working DESPITE back pain, joint pain, anxiety and depression.  These conditions should NOT be forcing people into a bleak future of on-going worklessness, especially because unemployment and poverty will WORSEN their health and well-being — and that of their families.

Needless job loss can occur because of decisions that doctors and employers make as well as decisions made by workers, their lawyers, and insurance companies. Anyone who COULD have actively supported a worker in staying at work but DIDN’T plays a part in unnecessary job loss.  Doctors may thoughtlessly select treatments that worsen instead of improve function, or impose work restrictions that “over-limit” someone who COULD actually perform their job.  Employers may refuse to make temporary adjustments that WOULD permit recovery “on the job” — and as a result workers sit home and begin to believe they really are “too disabled to work”.   Employers can refuse to engage in a real problem-solving discussion with workers that WOULD have let them come back to work with a very minor modification.  Employers can neglect to ask for help from a return-to-work expert who COULD have told them about a $200 piece of equipment or work process alteration that WOULD have made it possible for the worker to keep doing her regular job.  Insurers COULD routinely (instead of occasionally) make career counseling and job finding services available to workers who appear headed for job loss or have already been terminated.  Etc. Etc.

So, who DO you think should be held accountable for job loss in those situations?  You and I as taxpayers are going to pay benefits for the rest of these people’s lives if they end up on SSDI because the right things didn’t happen.  Less than 1% of SSDI beneficiaries ever come back off the rolls.

Here’s a place to see and comment on my DRAFT recommendations for what the government can do to create a lot more visibility for unnecessary job loss due to acquired health conditions and disabilities.  You can also contribute your own ideas on this matter at:  http://workashealthoutcome.epolicyworks.org/

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August 2, 2015

While I was at the White House …..

I was first bewildered then honored to be invited to a White House reception on July 20 to commemorate the 25th anniversary of the ADA.   The invitation was completely unexpected.  It  arrived by email and in the sender field was “The White House”.  I actually wondered for a moment whether it was spam!  I couldn’t figure out HOW my name had gotten on the list — but I went, of course!   It was certainly an experience to remember.  Here are four of my favorite moments.

 

1.  Meeting former Senator Lowell Weicker and his wife — and the surprising result of my little good deed

When the man in the wheelchair to whom I had just introduced myself said that he was former Senator Lowell Weicker (from Connecticut), I asked him why he was here.  He said, “I wrote the ADA.”   Some web research after we got home confirmed that fact:  an ADA Legacy website calls him the “Father of the ADA.” He left the Senate before the significantly amended bill he had originated could be enacted into law.  Senator Weicker also said that writing the ADA was one of the two things that he was most proud of in his entire Senate career.   It was especially poignant to hear this from an 84 year old man in a wheelchair, clearly looking back over his life.

Weickers

About a half hour later, when President Obama started  his remarks, he began by acknowledging the contribution that had been made by various influential ADA big wigs in the room.  Sadly, he never mentioned Senator Weicker.

The next day, I screwed up my courage and sent an email to the White House.  I addressed it to the person who had confirmed our RSVP and arranged our security certification.  Maria’s signature read Associate Director, White House Office of Public Engagement.   The heart of my message read: “I presume that others have alerted you to this issue already, but I believe the President delivered an unintended insult by omission yesterday.   I certainly hope that he apologizes to former Senator Lowell Weicker of Connecticut for failing to publicly acknowledge his presence at the ADA reception yesterday and his enormous contribution as “father” of the original bill that became the ADA.    Personally, I hadn’t been aware of the role Senator Weicker had played, but I just happened to strike up a conversation with him at the event.”

To my ASTONISHMENT, Maria CALLED ME UP a few hours later!  She said they were going to have the President write a letter – and then we had a great chat.  It turns out she is the White House Disability Liaison!   She confirmed that they got my name from the Acting Assistant Secretary of Labor Jennifer Sheehy, in part due to my presentations about the work disability prevention model in various DC forums, and my participation in the Stay-at-Work & Return-to-Work Policy Collaborative sponsored by DOL’s Office of Disability Employment Policy.  Maria also said that they make sure to include some future-oriented people in nostalgic events like anniversaries.  I was finally reassured – my invitation wasn’t a mistake!   And now someone in the actual WHITE HOUSE has heard about our exciting ideas about preventing needless work disability!

 

2.  Here’s proof that medicine was a better career choice for me than photo-journalism

The crowd started gathering to hear the President speak. I decided to avoid the crowd. I stationed myself to catch a close glimpse of him as he was escorted swiftly out of a private corridor into the East Room.  In the excitement, here’s the best / only photo I got– the backs of the heads of the President and Vice-President!   (By the way, as they walked out, I was suddenly reminded that even super powerful people are plain old human beings. For example, their bodies do not glow, have
no visible aura or anything – and there’s no awesome sound track.)

Backs of heads - POTUS, V-POTUS

 

3.  The ADA has transformed lives of people with disabilities — but not everywhere

When it came time for the President to speak, he was introduced by a lively young women from Harvard Law School who is both deaf AND blind. She reminded us that much of the world has no ADA. Her African grandmother has been astonished at what has been possible for her here in the US, since no-one in Africa could imagine such a future for a child like her. She also said that at the beginning, Harvard didn’t know if and how they could accommodate her, but that they were willing to see if they could do it together. Now THAT is the attitude I wish we would hear from more employers!

Woman introducing Obama

 

4.   Looking back while leaving to savor the beauty.

On the walk back down the long hall  to the East Wing exit where we had come in, I snapped a photo of the garden, looking back towards the main White House.  I never dreamed that the most memorable thing about the White House would be its classic beauty.  To my eye, the style of the place evokes the noble yet practical-minded men who founded this country. It also evokes the Age of Enlightenment and the ideas about what it is possible for human beings to be and to become that undergird and sustain this fragile compact with one another that we call a nation. I feel very happy to be part of this continuing American “experiment”.

Garden looking at White House

 

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