Worker's Comp

This month, I'm doing an occupational medicine elective. I wasn't sure what all that entailed until I met with Dr. Schaub, my preceptor, yesterday morning, and I'm still not completely sure, but here's what I've gathered thus far: most of my days will be working in one of two occupational medicine clinics in Columbus, and I'll also being spending half days doing hospital epidemiology at OSU, work-site inspections at major corporations in Columbus, and working with FAA flight surgeons. Thus far, I've done half a day in the occupational medicine clinic.

Occupational medicine clinics aren't primary care offices, and occupational medicine docs aren't primary care physicians. The only reason for the visit, and the only concern of the physician, is what was injured while the patient was at work. People on worker's comp have to see occupational medicine specialists on a regular basis, for continued evaluation of their injuries, to determine if they are fit to return to work (and what duties they can do there), and to coordinate care with other specialists. That is all the doc is worried about--no lecturing the patient about not taking their blood pressure medicine or checking their blood sugar.

So before I began my shift yesterday, I was given the half-hour lecture about worker's comp and how it works. Dr. Schaub explained by explaining how things were before worker's comp: if you were injured at work, the only way you could get money for your medical bills and lost wages was to go through the tort system, and to do that you had a hire a lawyer (obviously), and had to prove you were injured at work (not so difficult if you came to work with ten fingers and left with nine, but more iffy if you developed lung disease after working in a coal mine for thirty years). There was also the assumption of risk, meaning that there were certain risks at every job, and if the employer told you about the risks, you accepted that you were okay with them when you started working there, and thus, any injury as a result was not the employer's fault.

Now, with worker's comp, it's completely non-tort--in fact, you can't sue your employer if you're injured at work. No lawyers are involved, and all that you have to indicate is that there is a "reasonable medical probability" that work contributed to the injury, so now that covers things like Black Lung Disease from coal mines, carpal tunnel syndrome in secretaries, etc. There is no assumption of risk; if the job-site isn't safe, it's now in the employer's best interest to make it so, in order to keep people from getting injured.

The biggest misconception about worker's comp is that it's permanent disability; it isn't. That's social security. Worker's comp only pays temporary total disability, and if you can't get back to a job before that expires, you're done. Notice I said a job, not your job--employers may have you come back doing something that won't aggravate the injury, and if you can't handle that, you may need to get a new job. One nice thing about this is if it becomes obvious that you can't go back to what you were doing, you could be enrolled in vocational rehabilitation, which helps you find/train for a new job that you can do with your injuries.

So yesterday we saw a variety of patients, from a legal aide with carpal tunnel (we had a laugh together about that one, as we both had our wrist braces on), to a TSA agent recovering from a broken knee after a fall while he was searching a passenger, to a woman who was going to have to enter vocational rehab, as she had been making no progress gaining strength in her arm after a fall on her shoulder a year ago. Many of these patients were eager to get back to work doing something; in fact, the legal aide was still doing a lot of typing on a daily basis.

I guess I never really considered how a relatively minor injury could sideline someone in certain positions. For example, we cleared the TSA agent for full-duty yesterday, but he still could not kneel on his right knee without pain, which means that while he's searching passengers, he'll have to remember to drop to his left knee, and while he's lifting luggage, he'll have to remember to support it with his left. We also had a correction's officer with a sprained thumb who couldn't go to work at all; even the most limited-duty jobs (ie, watching monitors) could conceivably require her to restrain a prisoner, and without grip strength of her hand, she couldn't grab someone and put them in handcuffs. Sometimes, it's all about putting the injury in perspective.