Category Archives: Innovations, New Things

October 9, 2015

A Health & Work Service could prevent or reduce impairment/disability

 

There is definitely an opportunity to make a positive difference BIG ENOUGH to make the expense and effort of developing, launching and delivering a nationwide community-focused Health & Work Service (HWS) worth it — in my opinion.   (Our proposal for establishing the HWS was among 12 ideas selected for development as part of the Committee for a Responsible Federal Budget‘s SSDI Solutions Initiative on Capitol Hill.)  There are two main reasons why this opportunity exists.

First reason:  Years of research have shown that some of the unfortunate secondary consequences of illness and injury — certain kinds of impairment and work disability — CAN sometimes be prevented or reduced.  This is particularly true in people with the most common chronic musculoskeletal conditions (MSK) especially low back pain, and the most common mental disorders (CMD) like depression and anxiety.  And research has also shown that intervening early in the unfolding of an injury or illness episode can have a very favorable impact on the long-term outcome.

Second reason:  Millions of workers in America fall through the cracks in our society because they have no access to services or expertise that might protect them against job loss after injury or illness, or they experience service failures.  Many of them work for employers that do not offer health or disability insurance, or that are excluded from the requirement to buy workers’ compensation insurance.  Many work for small companies that are exempted from the Family Medical Leave Act which protects jobs for 12 weeks when employees have health problems, or the Americans with Disabilities Act which requires employers to make reasonable accommodations for employees with disabilities.  In addition, there are many people who are the victims of neglect or poor decision-making by those with authority over some aspect of their situation.  Sub-par employees headed for termination exist among the administrative staff, professionals, supervisors, and managers in every organization, including every medical care facility, workplace, and benefits claims administration organization.  Before leaving, each of these sub-par employees has probably had an impact on hundreds of vulnerable workers.

Therefore, it is not correct to assume that all of the people who are now on SSDI due to these common health problems had the worst (most severe) form of their particular MSK or CMD from a biological/pathological perspective, and that nothing could have prevented their entry into SSDI.  While undoubtedly true in many cases, it is also likely that a sizable number of them lost their footing in the world of work and ended up on SSDI because of events that occurred in response to their health condition—not the condition itself. Their lives fell apart due to a cascade of adverse secondary consequences of the initial medical problem, and after a time SSDI became the best option for survival.

Remediable or Avoidable Reasons for Poor Outcomes

At the moment when the common health problems of this subgroup of SSDI recipients first started, these people would often have looked very similar to other patients with the same diagnosis and objective clinical findings—but who then experienced good recoveries.  This is because the factors that predict poor outcomes (serious impairment and prolonged work disability) as a consequence of MSK, especially low back pain, are not tightly related to either the specific diagnosis or the extent of the pathology. Although less research has been done on factors that predict poor outcomes in CMD, and diagnosis does play a more significant role, there are other important non-medical factors.

Some of the factors that predict poor outcomes are immutable (such as age, past medical history, work history, and geographic location). But other factors are potentially remediable such as elapsed time out of work, uncertainty and distrust due to lack of communication or information, uncoordinated or inappropriate medical care and advice, low expectations of recovery, excessive vigilance, catastrophic thinking, false beliefs, fear of movement, self-limitation, perceived injustice, and lack of employer support. Today, those who handle these situations do not typically look for any of these remediable problems and address them.  And none of the professionals involved has been trained to feel responsible for driving the situation forwards towards a good outcome .

The standard medical care process is simply inadequate to help people in these situations avoid poor life outcomes. What is needed is coordinated activity during a fleeting opportunity to address and resolve a set of pivotal issues (both medical and non-medical) around the time the condition starts interfering with work—issues that will set the situation off onto the right or wrong path.

The first few days and weeks after onset are an especially critical period during which the likelihood of a good long-term outcome is being influenced, either favorably or unfavorably, by some simple things that either do or do not happen during that interval. It is the optimal window of opportunity to improve outcomes by simultaneously attending to the worker’s basic needs and concerns as well as coordinating the medical, functional restoration, and occupational aspects of the situation in a coordinated fashion.

The best opportunity for basic intervention appears to last about 12 weeks or three months, although some data shows it ending by 6 months.  Many studies have show that a modest set of simple services—that embody an immediate, systematic, pro-active, integrated, and multidimensional approach—can mitigate the potentially destructive impact of common injuries, illnesses, and chronic conditions on quality of life among the working population.

In summary, the way a health-related episode that disrupts work unfolds over time in all dimensions—biological, psychological, social, and economic—can have a big impact on the outcome. Events that occur can either mitigate or aggravate existing risk factors in the situation, leading to better or worse outcomes. There are usually many opportunities to actively influence the course of events immediately after onset of a health problem (and many fewer opportunities later on), but today there are few resources devoted to finding and exercising these opportunities. Most of the current attempts to steer situations to a better outcome are made long after the best opportunities have passed by.

If you’d like the references for the research mentioned above, get a copy of our full report when it is published by the CFRB later this month (electronically) or in January (in print).

Bottom line:   If you agree that the USA needs a community-focused Health & Work Service, contact your Congressional representative, tell them you like our proposal and recommend that it be included in the 2016 SSDI reform legislation package.  Or even better yet, take a grass-roots approach.  Team up with other like-minded people to see if a local charity or foundation will fund your efforts start a HWS in your own community!

 

 

 

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October 8, 2015

Dan Siegel says I can use my mind to reshape my brain — or YOURS!

I’m in the middle of taking an on-line course by Daniel Siegel, MD.  I hope you do, too.   It’s called “Practicing Mindsight” — 6 hours consisting of 32 video mini-lectures delivered live to an audience of about 240 mental health professionals, physicians, educators, as well as organizational behavior and social policy wonks.   (I’ve also  heard a great TED talk by this guy).  He’s a famous psychiatrist, trained at Harvard Medical School and UCLA, now clinical professor of psychiatry at UCLA, an award-winning educator – and expert researcher in the emerging field of “interpersonal neurobiology”.

It’s on a website called www.Udemy.com.  I’ve listened to the first 9 mini-lectures so far.  He began by asking how many of the professionals in the audience think the mind is important in everyday affairs — and in their practices/organizations.  All hands went up.  Then he asked how many had any instruction on what the mind is?   Five percent raised their hands.   He says that the proportion has been similar in 85,000 professionals he has asked.   He  says the purpose of the course is:  How to see the mind and make it stronger.    I say the course is focused on STRATEGIES for changing the STRUCTURE of the brain (one’s own and that of one’s patients/clients) by using the mind.   Think of that:  USING the mind as a tool to INTENTIONALLY remodel circuits in the brain.

Here are three big points I have heard in his lectures so far:

(a) Key definition:   The mind is a PROCESS not a thing.  It REGULATES (monitors and directs) the flow of energy and information both within an individual and between people.  (Energy is roughly defined as stuff that makes things happen.  Information is both data and meaning or story.)  As part of his grant-funded work, he had put together a group of 40 researchers in a wide variety of fields who were all (eventually) able to agree on this definition.

(b) “Attention” – which is where the mind focuses, what it is paying attention to  – is what CREATES new neural pathways, and STRENGTHENS either existing or new ones by reinforcing the pathway.  As the saying goes: “neurons that fire together wire together”.  For example, the more we pay attention to our pain (assessing it, worrying about it, “fighting” it), the deeper we are carving that channel.  Common sense, grandmothers, and “New Agers” have been telling us for years to focus on what we DO want instead of what we DON’T want  — and now science is confirming it.

(c) Humans are genetically programmed to AUTOMATICALLY create internal experiences and capabilities that mirror or incorporate things they see or feel during interactions with others.  As we watch someone else raise a glass of water to his lips, the cells in our brains that move our own arms light up.  We sense his intention to drink, we may experience thirst, or the sensation of water or of refreshment.  We feel sad when someone cries, and are happy at their joy.  Others’ brains shape what goes on in ours —  what circuits are firing and being reinforced — and vice versa.  Simultaneous mutual (interpersonal) experience is a KEY part of the “social” in our “social species”.

So I got this:  The techniques we use to SHIFT our attention (or another person’s attention) away from bad stuff and towards more productive ways of thinking are actually MODULATING neural circuitry in the brain (which is neuroplasticity in action).  This has now been confirmed by rigorous research on techniques such as mindfulness, CBT, etc.   (I personally remember reading a study which showed that SIMILAR changes in the brain can be observed after either medication OR “talk therapy”.  In that TED talk by Siegel that I watched, he asserts that much of the circuitry in our frontal lobe is created and shaped by everyday INTERPERSONAL INTERACTIONS which DEVELOP it – and of course it is our frontal lobes which make us uniquely human.)

The takeaway for us as physicians in tangible organ-system-focused specialties is there is POWER TO HEAL in our words —  and in the human quality of our interpersonal interactions.  We have an opportunity to INTENTIONALLY HARNESS that power and explicitly add it to our therapeutic armamentarium.

Although the mental health professions already are aware of the power of words and relationships, physicians are on the front-line dealing with patients with PHYSICAL complaints and distress.  We are in the best position to use the power of words and relationships to start relieving those symptoms and easing that distress — even if all we do is alert the patient to the healing power of the mind and persuade them to accept help from a mental health professional.  Apparently, the only specialty these days that requires training in patient communication is family practice.  Thus, this appears to be a neglected skill area in all of the other medical specialties.

Those of us who have accepted the idea that sickness and disability are the COMBINED product of bio-psycho-socio-economic factors, and who are setting out to reduce the disruptive/destructive impact of injury/illness on quality of the patient’s everyday life and future – especially in at risk cases and “heartsink patients” — MUST master this stuff.  We need to practice the SCIENTIFIC ART of empathic therapeutic interaction.  We must learn how to effectively redirect the patient’s attention into more appropriate channels so they develop their own capability to adapt to / cope effectively with their own situations.

The tuition for the Siegel Practicing Mindsight course is usually $137, but if you follow the directions below, you may be able to get a $39 special rate.  It supposedly ends TODAY — although it supposedly ended yesterday, too.  Some people don’t seem to be able to find the $39 offer.  There’s probably a glitch of some kind that is making it show up only when you wend your way through the electrons a particular way.

Here’s how I found it again just now:  I use Firefox.  I entered  “daniel siegel mindsight” in the search box, then I clicked on the link for an Udemy ADVERTISEMENT that appeared in the top left corner of the search results.  The website that appears says the rate is $39 again today (coupon valid until October 8).   But when I went STRAIGHT to the udemy site, the cost is $137.

Go for it — fool around, and then REGISTER!   But bring your brain AND appreciation for quirkiness with you.   This is  fascinating material taught by a deep and independent thinker, serious expert and experienced researcher.  And, Siegel is a character with really colorful personal stories:  so far we’ve heard tales of misfittery in medical school, salmon fishery, dance, nudity in Greece, etc.

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July 20, 2015

My “mini-manifesto” to reduce spine disability

You may be interested in the “mini-manifesto” I delivered this past Saturday 7/18 at the Spine 10×25 Research Summit in Chicago hosted by the North American Spine Foundation.  They have declared a worthy and very ambitious goal:  to reduce spine disability by 10 percent by the year 2025.  Thus the name: Spine 10×25. Pronounce it like you’re buying lumber – “10 by 25”.

(You can see the video and listen to my talk —  or even the ENTIRE 8 hour event because it was live-streamed and recorded.  Click here to do so.  Advance the recording by moving the blue dot along the horizontal line.  My talk starts at 5:31:50 and goes until 5:51:30.)

Do you know of any other medical group that has drawn a bold line in the sand like that?  I don’t.  It had never occurred to me that a professional society would set out to measurably move the needle.  They just don’t take on that type of project.  Most healthcare professional associations content themselves with pontificating:  being experts and telling other people what to do and how to do it.

My own professional society (ACOEM – the American College of Occupational & Environmental Medicine) has made many significant contributions to society.  In particular, our evidence-based treatment guidelines are very well regarded and in use by several states.   ACOEM has produced many other useful publications that have had a positive impact.  In fact, some of them were developed under my leadership.  But, in the end, they all amount to pontification.

In 2006, I told ACOEM I didn’t want one of those documents to just sit on an electronic shelf. We had developed it in order to introduce the work disability prevention paradigm and shift the way all stakeholders think about work disability.  Entitled “Preventing Needless Work Disability By Helping People Stay Employed“, that report needed to go out into the world.  Thus, the 60 Summits Project was born to carry it into the 50 US states and 10 Canadian provinces of North America.  We created groups of volunteer professionals who planned and held 20 multi-stakeholder summit-type conferences in 12 states and 2 provinces.  We invited the attendees to consider ACOEM’s 16 recommendations for improving the stay-at-work and return-to-work process.  We asked them to decide if they liked each recommendation, and if so, to make a plan for how they were going to carry it out in their own business, community, and jurisdiction. (60 Summits eventually ran out of money and was mothballed.)

Then last month, the boldness of the Spine 10x 25 initiative made me realize that even The 60 Summits Project had a pontification angle to it.  Propagating a new way of thinking and discussing a set of recommendations for change is not the same thing as CARRYING them OUT.  I felt compelled to go and check out these NASF people and participate in their Spine 10×25 Research Summit.

My assigned topic was “Precedents and Prospects for Success” in a 15 minute time slot that got expanded to 20.  It seemed important to speak straight and share my ideas about what needs to be true in order for their goal to be realized.  I offered the audience a (draft) conceptual foundation to use as a context for change, as well a summary-level vision of the way things will look in the future WHEN things have ACTUALLY changed and spine disability is BEING REDUCED by 10%.  View it here. Remember to advance the recording to 5:31:50.

I may expand a bit on some of the main points of that mini-manifesto in later posts.  I developed all of those slides at the conference in order to take into account what the speakers said who had gone before me!  Luckily, I also had some time at lunch.  The tight time limit meant a few big ideas got short shrift.

 

 

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July 7, 2015

Free on-line CBT course helps Australians living with pain feel better

An Australian study in the journal Pain reports that a FREE on-line course that employs CBT techniques has worked well in helping patients with chronic pain reduce both distress and other symptoms  — no matter how much contact the patients had with a clinician during the several week course – and it clearly outperformed “usual care.”

The Pain Course was developed by psychologists as part of a non-profit initiative of the Centre for Emotional Health, part of Macquarie University in Sydney, Australia.  Their tagline reads:  “Developing effective, accessible and free psychological treatments …”   Before you get TOO excited, this particular course and the other on-line offerings of ecentreclinic.org which developed it are only open to residents of Australia.

Here’s a bit more about this group from their website:   “We comprise a team of psychologists, psychiatrists, and research staff….The eCentreClinic is a specialised research clinic that develops and tests state-of-the-art free online treatment Courses for people with symptoms of worry, panic, social anxiety, OCD, PTSD, stress, depression, low mood and other health conditions including chronic pain. We built the eCentreClinic because millions of Australian adults suffer with these symptoms and conditions each year. But, most do not seek help or see a mental health professional. We believe that people have a right to helpful information and to know about practical, proven, skills that help. We hope that by providing this information and supporting people to learn these skills via the internet more people will learn to master their symptoms and conditions. By doing this we hope they will also improve their quality of life and that of their families and communities.

Here’s a link to the abstract.   It is is an open access (free) article, so you can also download a pdf of the entire article here.

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July 6, 2015

Why Put People Who Don’t Care in Charge of Timing?

I just realized that there are two short little sentences that are causing BIG PROBLEMS.   They are:

1.   “We can’t start looking for transitional duty for him  (or, we can’t start the reasonable accommodation process) until we get specific work restrictions from the doctor,” says the employer.

2.   “She will be eligible for job training only after her condition is declared to be medically stable (at MMI or P&S) and permanent work restrictions for all body parts are known,” says the benefits administrator.

These two sentences reveal that the speaker is in a REACTIVE posture, refusing to make an effort to get out ahead of the ball.  They are passively waiting for a PHYSICIAN or the POLICY/LAW to determine the timing of an important event  — an event which could have a huge impact on the outcome.   The problem is:  neither the physician nor the insurance policy/law are watching time slip away.

I hear these two sentences frequently during the part of my week when I serve as a physician adviser to a multi-disciplinary care management team.  Since many of the standard techniques to manage claims have previously been tried, I often suggest non-standard things.  I tend to hear those sentences AFTER  I suggest doing something pro-active in a case that’s stalled out and headed towards a predictably poor outcome.  For example, I may recommend that INSTEAD OF WAITING, we approach the doctor with an proposal for a return to work plan and some potential transitional tasks.  Or I may recommend that we acknowledge the obvious handwriting on the wall — which says the person is never going to go back to the original employer — and offer the worker some psychological or vocational counseling to help them start focusing on the future and figure out what kind of work they want to do and how to find a new job.

The PHYSICIAN doesn’t know that the longer employed people are absent from work due to a health condition, the more likely it is that they will lose their jobs, never get another one, and end up on as a long-term disability claimant.    And with a conventional medical education, the doctor doesn’t feel responsible for helping patients stay employed.

So WHY is the employer WAITING for the doctor?   WHY can’t the employer ANTICIPATE the general nature of the limits/restrictions?   If the shoulder has been affected, it’s obvious the restrictions will involve lifting and reaching!   If it’s the right foot, it’s obvious there will be limitations on walking and standing!   If you’re uncertain what workers can do, ASK them!  (The Americans with Disabilities Act expects you to do so.)   If the employer and the employee propose a plan to the doctor that they both agree on — what are the odds the doctor will say no?  VERY LOW!

The POLICY or LAW describes outer limits, not the best path.  The law usually dictates the earliest or the latest date when something must occur —  not the optimal timing of it.  So WHY is the benefits handler WAITING for the formal declaration of MMI / P&S?  This too is not part of conventional medical training.  Most doctors don’t see it as a milestone and are unaware they’re supposed to make a formal statement.  I suspect that benefits handlers are so worried about violating rules and regulations that they think they HAVE to wait to start helping a person move on and find a new job until the LAW MANDATES it.  Why can’ t that benefit handler VOLUNTARILY make a move earlier?

Seems to me that determining the OPTIMAL timing for events, and deciding whether to offer BETTER assistance than the minimum specified in the law lies within the discretionary authority of the benefits handler.  In fact, aren’t we supposed to be paying them to use their judgement?

[CAVEAT: This has been true where I have worked, but maybe in some jurisdictions or policies, I’m wrong.  If you are more expert on these matters than me, please tell me why I’m incorrect.]

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June 17, 2015

Communications Clarity Dept: Useful distinctions

I keep getting reminded how fuzzy words can be — and how much clarity matters to those of us who work across traditional boundaries between specialties, disciplines, or sectors of society.

We just submitted in a paper that will be presented at the McCrery-Pomeroy SSDI Solutions Conference on August 4 and then published later this year.    During the peer review process, it became clear that we, the authors, were confusing readers by using terms differently than they do:  “disability,” “early intervention,” and “recovery” .  So in our new and improved version of the paper, we began by making three key distinctions.  I offer them to YOU, in case they are useful.

Disability vs. Work Disability
According to the ADA, disabilities are impairments affecting major life functions (such as work).  In the world of employment and commercial insurance, work disability is absence from or lack of work attributed to a health condition.  Having a “disability” need not result in “work disability”, a core concept embodied in the Americans with Disabilities Act.   Similarly, having a health problem need not (and usually does not) result in work disability.

What this might mean for you:   Train yourself to add a modifier in front of the word “disability”, especially when you are working with someone in another organization or discipline.    I try to say “work disability” or “impairment disability”– because even if I define how I’m using the word “disability,” people LISTEN their habitual way. 

Medical Recovery vs. Functional Restoration
Medical recovery refers to the resolution (disappearance or remission) of the underlying pathological process.  Functional restoration refers to re-establishing the usual rhythm of participation in everyday life.  That means the ability to go about one’s regular daily business: performing necessary tasks and enjoyable activities at home and work, and participating fully in society.  Functional restoration does not necessarily require medical recovery.  It may include figuring out new ways to accomplish the stuff one needs or wants to do.  So function can be restored through rehabilitation (broadly defined), and can even include the successful use of assistive technology, adaptive equipment, and/or reasonable accommodation in the workplace.

What this might mean for you:   Remember to consider these two issues separately in every case.  In order for the affected individual to end up with an optimal outcome, especially when there’s not much to offer on the medical side, paying specific attention to functional restoration is important.

Early Intervention vs. Immediate Response
Our opportunity to influence the occupational outcome of an injury or illness episode DOESN’T really start the day a problem is reported, or the day YOU first get involved. The opportunity clock DOES start on the first day an affected individual stays home from work or admits to having difficulty working – because that is when the period of life disruption and uncertainty starts.    A pro-active work disability prevention program involves immediate response which begins within the first few days and no later than 6 or 8 weeks after onset.  This triggering event (and timeline) is different from the so-called early intervention used in many programs.  In general, those programs start from an administrative date:  claim notification,  date of referral or application for benefits, etc.  It is PATHETIC to see how LATE most referrals for early intervention are ACTUALLY made:  typically 6 or 9 months.   Naturally, the intervener WANTS to look responsive to the paying customer so they hop on the case promptly, within 48 or 72 hours. But hey:  Life moves at the speed of life, you guys, not administrative procedures.

What this might mean for you:   It is inappropriate to let anyone get away with counting from administrative dates — unless you are content with LOOKING responsive rather than BEING helpful.  On EVERY chart or file, keep an on-going record (at every visit or update) of how many days have elapsed since the episode began.  Also include data about how many days it typically takes someone with that particular condition to get back to work.  It will keep your and your collaborators’ feet to the fire.

Personally, when I’m doing my physician version of case management,  I use MDGuidelines.com to keep track of how long the episode SHOULD last, and a website called timeanddate.com to calculate elapsed time to date.   I put those numbers at the top of my reports. This keeps me and my customer REALLY aware of the passage of time, because otherwise, the days just keep slipping away — along with the individual’s chances of EVER going back to work.

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June 15, 2015

Introducing Dave Clarke MD & the Psychophysiological Disorders Society

I had the honor of meeting a innovator in medical CARE on Sunday:  David Clarke, MD, founder of the Psychophysiological Disorders Society.   He is a gastroenterologist by trade who has developed expertise in diagnosing and compassionately treating what he calls “stress illness”  — distressing symptoms and even physiological upsets  — without any actual evidence of disease.  Stress illness is an extreme version of the body expressing what is going on in the brain (upsetting thoughts, feelings, emotions, memories, etc.)  However, we are ALL familiar with the more common everyday versions of this same thing:  sweaty palms and butterflies in stomach when worried, blushing when embarrassed, diarrhea or constipation before or after a stressful event.  Although we don’t THINK of these things as the brain expressing itself through the body, that’s what it is.

Stress illness occurs for many reasons, but one of them is because other communications channels are blocked.  Long before I got my professional education, my family taught me that people who bottle up their feelings —  who won’t let themselves cry or be angry — are going to have those feelings leak out somewhere else.  It’s a form of pent-up tension..

Dr. Clarke’s book (and audio CD) are on Amazon, entitled “They Can’t Find Anything Wrong“.  You will find many case stories that illustrate (a) the power of stress to cause bodily dysfunction / symptoms; (b) the healing impact of simply noticing then acknowledging the contribution that stress is making to symptoms; and (c) the various sources of stress:  current life predicaments; childhood trauma; PTSD; anxiety and depression.  As Dr. Clarke said, some of his patients were “cured” as soon as he listened and ask questions until they SAW the connection — and accepted it.  Others needed to learn more — read a book or two, look things up on the web.  A third group needed to spend some time working with a good mental health professional to learn how to feel and release the pent-up stress, and then learn better ways to deal with the ups and downs of life.

There are several medical terms for this puzzle of distress without disease:   medically-unexplained physical symptoms (or MUPS), somatization, and functional disorder are among the most widely used.  They all describe cases in which the patient feels sick and is complaining of symptoms but there is no objective evidence of pathology .  Often, an organ or system is not functioning normally, but there is no sign of any disease process.  In other words the “doctors can’t find anything wrong!”

I wondered if there are any estimates for how frequently this occurs.  Turns out this type of disorder accounts for a surprisingly large fraction of all visits to doctor’s office — estimated by various researchers as 25 to 60%.

Maybe we should think of it this way:  Just like our facial expressions sometimes betray us even when we’re trying to keep a poker face — our bodies do the same thing.  The body is just another channel the mind / spirit / brain can use to express itself — whether we are aware of it or not, and whether we want it to or not!

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June 12, 2015

First-ever CDC-sponsored “disability prevention” event

Even if you missed it, you can still listen in to a milestone event:   the first-ever public webinar hosted by a federal government agency on the topic of “disability prevention.”   The umbrella hosting agency was the CDC (Centers for Disease Control) which is the main preventive health arm of the Federal government.

The webinar was actually put together and co-sponored by two specialized units buried deep inside the CDC:  the Center for Workers’ Compensation Studies and the Office for Total Worker Health within NIOSH (National Institute of Occupational Safety and Health).  It was an EXCELLENT kick-off  that I hope reflects a sea change and expansion of focus at NIOSH — and maybe eventually the CDC.

Two invited experts spoke about SECONDARY PREVENTION:  mitigating the impact of injuries and illnesses after they occur by preventing adverse consequences.   This is quite different from NIOSH’s traditional focus on PRIMARY prevention:  avoiding the injuries or illnesses in the first place.

The event wasn’t perfect.   Listen carefully and you’ll notice vocabulary problems — a signal that the speakers, the sponsors, and the audience are not yet quite on the same page.   Various people used the word “disability” to describe quite different  things.   For example,  some spoke about  preventing medical or anatomical problems:    obesity, diagnoses, symptoms, anatomic losses and impairments.   The invited outside speakers referred mostly to the dynamic impact of injuries/illnesses on everyday life:  loss of ability, activity limitations, work absence, loss of jobs and livelihoods, descent into a life of poverty and economic dependency.

The speakers’ POWERFUL AND FACT-FILLED presentations with many citations made the nature and extent of the problem of preventable adverse consequences of injuries very clear. They ALSO made it clear that these problems are NOT unique to workers’ compensation.  They are just EASIER to DETECT in comp because both medical AND wage replacement costs are captured in a single dataset.  Even the Q&A portion of the event featured good questions, pithy remarks, and revealing comments from listeners which led to stimulating dialogue.

The featured speakers were:

You can download pdf’s of the speakers’ powerpoint presentations at the end of the webinar.  If you would like a copy of the unedited transcript from the session, please email vqq3@cdc.gov.

Do make time to listen to it!  It will make you think.   Even though I attended the live event, I listened again because the VIIRPM was very high .  [VIIRPM = Very Important Information Rate Per Minute (smile) ].  Here’s a link to the webinar recording (audio plus slides)   https://nioshtwh.adobeconnect.com/p9law27cnd3/.

I’ve been wondering:   What do those vocabulary problems mean for us?  We need to agree on a lexicon, a shared language in which we use terms the same way across all Federal programs and our society (NIOSH, EEOC/ADA, ODEP, Social Security Disability, etc.)  I’ve already suggested a conference on this to the NIOSH people. In addition, we also need an even bigger term to cover ALL the preventable bad stuff that happens in so many domains of life  — and can turn what should have been a short-term hiccup in life into its ruination.   Here’s a laundry list of outcomes we want to avoid:  (a) preventable impairment and functional loss (due to inadequate or ineffective treatment), (b) preventable secondary medical conditions (such as obesity and depression); (c)  iatrogenic illness (such as opioid addiction and drug side effects); (d) over-disabling (due to false beliefs and lack of patient education), (e) avoidable job loss and withdrawal from the workforce, and (f) people leading purposeless lives of social isolation, economic dependency, and poverty who COULD be participating fully in human life!  These are the poison fruits of a system whose gaps and holes reflect a lack of commitment to assuring that the right things happen when a working person’s life is disrupted by injury or illness — no matter the cause.  So, we also need a big term to describe what we DO want to happen, and the better outcomes we want.

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