How to Be a Good Worker’s Comp Doc

Written by on September 28, 2012 in Practice tips - No comments

Physicians do a disservice to patients with work related injuries by not understanding basic “return to work” practices.  Given the same injury, patients who go back to some type of productive work as early as possible have less long term disability, are more productive, and happier than those who are kept out of work.  In her article “7 Signs Your Injured Worker is Treating with a Physician Who is Not Employer Friendly,” Rebecca Shafer makes some excellent points about physicians treating worker’s comp injuries.  Her article is geared towards the payor side, so I will add comments that the treating physicians/providers need to consider when treating these patients.  (This is a huge topic, but these are the basics.)

  • Placing the patient off duty

As Ms. Shafer states, if a patient is off duty, it means they are totally disabled, as in the hospital, going directly to surgery or absolutely unable to move.  This is rarely the case.  Often times, the patient will tell the provider “there’s no light duty at my job.”  I generally explain to the worker that they will improve quicker if they return to some type of productive work immediately.  I further explain that I must first determine what their job duties are, then determine if the injury prevents them from doing the essential elements of the job. If they can return to full duty with only “first aid” level care, the injury may not even be OSHA recordable, which will help your clients (the employer) immensely.  If they cannot do their regular duties, physicians should write specific restrictions on what they can or cannot do in terms of stand, sit, walk, lift, carry, push, pull, climb, crawl, reach, grasp, etc., and how many pounds for what period of time–occasional, frequent or continuous.  Any physician providing workers comp services should have some type of form on which you can indicate these restrictions.

  • Follow up

After the first visit, follow ups, should be in just 2 or 3 days.  Many times the injury will be significantly improved and the patient can be returned to full duty.  Other times the patient will complain they are worse.  Should this occur, be sure not have a “knee-jerk” reaction and take them off duty, rather focus on their demonstrated level of functional ability in order to determine work status, not subjective complaints.  Be sure to always write the restrictions based on examination of their ability to function, and always explain that it is in their best interest to continue to work to this level of ability.   Generally, my subsequent follow ups are scheduled weekly.

  • Medications

If an injury is minor and the worker is returning to full duty, treat the injury as “first aid”, to avoid an OSHA recordable.  Prescribing OTC NSAIDs at OTC strength is generally fine for most minor injuries.  Remember, if you prescribe Motrin 600 instead of 400 it is going to be recordable.  If you are not completely familiar with what is or is not considered first aid regarding OSHA recordables, please refer to my article on OSHA recordables on my website at UrgentCareMentor.com.

  • Physical Therapy  

Yes, physical therapy (PT) can be easily abused, but also mandatory for injuries showing a functional deficit.  If the worker cannot return to full duty within a week or so, or if they are off duty and not in the hospital, I am aggressive with PT to restore mobility, function and also importantly, confidence and motivation.  I personally prefer having a close working relationship with the therapist so we are a team working to get the patient functional as soon as possible.  I did not have a PT department in my last urgent care center, but would if I had the space.

  • Specialist Referrals  

Obviously, if there is a surgical problem, the patient needs to be referred right away, and be watchful that do not end up in “limbo” with no duty prescription or excessive lost time waiting for the specialty appointment.  If the patient is not progressing, (e.g. showing signs of improvement in function, with progressive lightening up of work restrictions within 2-4 weeks), generally it is best to consult a specialist.

  • Communication

Yes, notes, restrictions, meds, PT, diagnostics, referrals and follow up plans, as well as expected date of maximal medical improvement (MMI) or prognosis should be legible and reported at each and every visit.

Treating injured workers effectively requires an understanding of proven return to work practices and strong cooperation and communication among providers, employers, adjusters, payers and patients.

by Lawrence Earl, MD

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