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.

Gap

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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July 31, 2015

Tell us: Who should be helping workers with health problems keep their jobs?

The US Department of Labor (DOL) wants to engage YOU in dialogue (you employers, insurers, physicians/healthcare providers, managed care companies — and working age individuals whose jobs have been affected by new or changed health conditions.) The dialogue concerns some draft recommendations for Establishing Work and Full Participation in Life as ACCOUNTABLE Health Outcomes.

The recommendations are part of a larger report I have drafted.  It is focused on these questions:
1– How can we reduce the number of working adults who lose their jobs or leave the workforce after their ability to work has been disrupted by a health condition—and conversely, how can we increase the number who get the help they need to stay employed?
2– What will create widely-shared social agreement that preserving/restoring the ability to work and participate fully in life should be seen as KEY OUTCOMES of healthcare for the working age population?
3– Who should be helping working people KEEP THEIR JOBS after acquiring a new or changed disability?    Who should be held accountable when they needlessly LOSE THEIR JOBS?
4– How can that accountability be established—for real?

The DOL’s Office of Disability Employment Policy (ODEP) commissioned this paper.  Many ideas for how to accomplish those things emerged after interviewing about 20 experts in various fields and discussing these issues with a Policy Work Group within ODEP’s SAW/RTW Policy Collaborative.  Because the stay-at-work and return-to-work process is by nature a “team sport”, the reality is that SEVERAL parties will need to be held accountable.

The draft report actually makes more than 20 detailed recommendations, but for now, ODEP would like to get feedback from YOU on the 6 main ones.  This is a reality check, to see if we’re on the right track in your opinion.   I ENCOURAGE you to disagree, make corrections, or suggest things that are missing or would strengthen the proposal.   The purpose of this exercise is to IMPROVE the report – and increase the chances that it actually has a positive impact.  The ultimate goal is to help more people stay in the workforce, remain productive contributors, and enjoy the many benefits of economic self-sufficiency and full social participation.

You can look at the recommendations on ODEP’s “crowdsourcing” website even before you decide whether to vote/comment.  I hope you will.   See the invitation from ODEP below to get started.   Again, FEEL FREE to disagree, to point out mistakes, make additional suggestions, etc. etc.

From: Acting Assistant Secretary of Labor – Office of Disability Employment Policy
Sent: Wednesday, July 29, 2015 3:40 PM
Subject: ODEP’s Latest Online Dialogue Discusses Work as a Health Outcome

 ODEP epolicyworks masthead 2015-07-31

Second Stay-at-Work/Return-to-Work Online Dialogue:
Establishing Work and Full Participation as Accountable Health Outcomes

Do you have ideas on how to reduce the number of working adults who lose their jobs or leave the workforce after their ability to work has been disrupted by a health condition—and conversely, how to increase the number who get the help they need to stay employed? If so, the U.S. Department of Labor’s Office of Disability Employment Policy (ODEP) needs to hear from you!

ODEP is hosting the second in a three-part series of important online dialogues, Establishing Work and Full Participation as Accountable Health Outcomes, to gather input on policy recommendations aimed at establishing work and full participation in life as accountable health outcomes. Through the use of an online crowdsourcing tool, interested stakeholders can provide feedback on these six draft policy recommendations.

Participation is easy. Just review the policy recommendations, register, then share your feedback.

Visit http://WorkAsHealthOutcome.ePolicyWorks.org/ before the dialogue closes on Friday, August 14th. If you have any questions, please contact ePolicyWorks@dol.gov.

Looking forward to your participation,
Jennifer Sheehy
Acting Assistant Secretary of Labor for Disability Employment Policy

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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 9, 2015

Here is where healthcare delivers VALUE — at the most fundamental level

When Professor Michael Porter did some “deep thinking” about where value is actually delivered in healthcare, he created a simple table that displays three tiers.   I found his second value tier EXCITING:   a Harvard Business School professor was validating my own “gut feel” about what really counts.   I summarize Porter’s three tiers this way (you can see his own table below this post):

Tier 1:   Delivering a desired health status — Avoiding death; optimizing health or extent of recovery.
Tier 2:   Minimizing the time it takes to restore the normal rhythm of everyday life — the cycle time required to produce a return to full participation in life (or best attainable level).
Tier 3:   Sustaining health or recovery, minimizing recurrences and iatrogenic (care-induced) illnesses and consequences.

Porter’s free article appeared in the December 23, 2010 issue of the New England Journal of Medicine.  In his comments on Tier 2, Porter said:  “Cycle time is a critical outcome for patients — not a secondary process measure, as some believe.”  I have focused most of my professional energy for the last couple of decades on shortening cycle time — because it clearly produces better overall life outcomes.  I hoped Porter’s article would catalyze a lot of discussion and much more attention to Tier 2 — but not much luck so far.

Personally, I believe that the purpose of being alive is to live a fully human life.  From that perspective, the most VALUABLE healthcare services are those that minimize the impact of illness or injury on the rhythm of everyday life.  I want all healthcare professionals to START here:   Our FUNDAMENTAL purpose is to avert premature death, relieve fear and suffering, and to enhance, preserve,or restore as quickly as possible every patient’s ability to participate in the specific activities that make life worth living — which for many includes productive engagement / work.

We are a social species.  We have an innate drive to be useful in some way, to have a role to fulfill.  We are happier when we have a clear purpose in life. Those of us in the middle years of the human lifespan are DESIGNED to work — to hold up our end and contribute to the well-being of our family, clan, community or nation.  The well-being of our country, and even more broadly, the survival of our species depends on maintaining the right balance between dependents and contributors.

The AFL-CIO’s website says this about work:  “Work is what we do to better ourselves, to build dreams and to support our families. But work is more than that. Work cures, creates, builds, innovates and shapes the future. Work connects us all.” As the Episcopal Book of Common Prayer‘s Order for Compline (an evening prayer service) poetically puts it:  “Grant that we may never forget that our common life depends upon each other’s toil.”

From What is Value in Healthcare by Michael Porter, NEJM 363;26 Dec 23, 2010, p 2479

From What is Value in Healthcare by Michael Porter, NEJM 363;26 Dec 23, 2010, p 2479

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July 7, 2015

#1 of 3 fleeting opportunities to influence policy recommendations

Between now and July 10, you have the first of three time-limited opportunities to preview and maybe influence the recommendations being made in three different policy papers that the Stay-at-Work and Return-to-Work (SAW/RTW) Policy Collaborative is producing this year.  Your input (as an experienced professional in this arena) will make it more likely that their FINAL recommendations are realistic and help accomplish their intended purposes.  Participation is easy.

The dialogue opportunity for the FIRST SET of recommendations will remain open just a few more days — until July 10.   The topic of this first paper is Expanding Access to Evidence-based, Early Intervention SAW/RTW Services and Supports, authored by David Stapleton of Mathematica.  His DRAFT main recommendations have been posted on-line at a “crowdsourcing” website for public review and comment, the National Online Dialogue.

To participate, simply register, read the policy recommendations, give it a thumbs up or down, or go deeper and make a substantive comment.  And please forward this email to any colleagues with an interest in the topic!

The SAW/RTW Policy Collaborative was created to advise the US Dept. of Labor’s Office of Disability Employment Policy (ODEP).   Members are invited by the project contractor, Mathematica, after approval by ODEP.  I have nominated many members all of whom have been accepted (as far as I know).  If you have expertise in this arena and would like to join and actively contribute to the Collaborative, please let me know.

I’m drafting the second policy paper entitled Establishing Work and Participation in Life as Accountable Health Outcomes.  Towards the end of July, my major recommendations will be put into the on-line dialogue.  Y’all come and give my proposals a thumbs up, thumbs down, make a suggestion or leave a comment!   Third in the line-up for dialogue will be the main recommendations from the third paper entitled Job Retention/Creation for Workers Who Experience Productivity Loss by Kevin Hollenbeck from the Upjohn Institute later in the summer.

Before the July 10th deadline, go to this link and provide feedback on Stapleton’s draft policy recommendations:  http://TargetingEarlyIntervention.ePolicyWorks.org/    If you have any questions, please contact ePolicyWorks@dol.gov.   And do remember to let other colleagues know about this SHORT-LIVED opportunity.

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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 18, 2015

Nancy’s super-simple guide to pain

Nancy Grover’s June 15 column on Work Comp Central is a super simple guide to pain for anyone who isn’t really interested in the latest science of neurophysiology — but who wants a basic understanding of how the science of pain is changing our view about how to treat it.

Nancy interviewed me and wrote her column after reading a white paper entitled Red Herrings and Medical Over-Diagnosis Drive Large Loss Workers’ Compensation Claims released by Lockton Companies.  I am one of the co-authors, along with Keith Rosenblum, senior risk consultant at Lockton Companies and Dr. David Ross, a Florida neurologist who is CEO of NeuroPAS Global,

Our goal was to draw attention to an issue that is driving UP costs for payers and driving DOWN quality and outcomes for patients.  In short, all of us (physicians and patients, claims payers, employers, lawyers, judges, etc.) have been getting seduced by the false certainty created by “objective findings” of diagnostic imaging, especially by MRIs.

Before proceeding with invasive procedures and expensive/risky surgeries (that often fail to relieve the pain or create worse problems), we really should be making a good faith effort to identify (and treat) other things that are either causing or worsening the patient’s distress.  Before that first cut is made — are we sure all soft tissue problems have been identified, and then treated by skilled professionals using evidence-based methods?   Have all emotional, psychological, and other human issues known to manifest as bodily distress been identified, and then treated by skilled professionals using evidence-based methods?

If you’re a WorkCompCentral subscriber, read Nancy’s excellent column Low Back Ache: A Pain in the Brain.  If you’re coming to the SIIA conference which is October 18-20 in Washington DC, plan to attend our session on Medical Red Herrings — I’ll see you there!   (SIIA = Self Insurance Institute of America)

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June 18, 2015

Pain-free without surgery — despite horrible-looking MRI

Sounds like at least one spine surgeon is in danger of working himself out of job.  Several years ago, David Hanscom, MD in Seattle developed an alternative to spine surgery called the Defined Organized Comprehensive Care (DOCC) program.  He says it helps people suffering with chronic back pain to calm down their nervous systems, starting with the anxiety and anger that chronic pain causes.  He offered the DOCC program to patients when he wasn’t sure that surgery was going to relieve their pain.  A lot of them got remarkably better — so better that they declared themselves pain-free.  The number of surgeries he did dropped, but his patient outcomes improved overall.  The non-surgical patients got better, and the surgical ones did too — because now he was only operating on the ones where it was crystal clear they needed the operation.

Then he took it up another notch.  Based on the success of the DOCC program, Dr. Hanscom decided to try using it to prepare people who had already been scheduled for surgery to have a smooth post-operative recovery.  We’re talking about people with horrible-looking MRIs that revealed structural problems entirely consistent with their symptoms.  The result has stunned and delighted him.  He says that more than 40 of these people have decided they don’t NEED surgery anymore after the DOCC program because their pain has pretty much gone away!   See more about this surprising development on his recent blog posting.

And if you work with people with back pain, or have the problem yourself, go to Dr. Hanscom’s website Back-in-Control.com and start calming down YOUR nervous system too.  The DOCC program is all laid out on the website — and it’s free.  All that’s needed is an open mind and the willingness to try a different path up and out of that deep hole.

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