By Maja Jurisic MD, AVP & Medical Director for National Accounts, Concentra
Editor’s Note: To read part one, click here.
Last weekend my husband and I enjoyed one of summer’s delights, live outdoor theater. As we watched a brilliant production of Hamlet, and the Prince of Denmark asked himself “to be or not to be,” it reminded me that the existential question which physicians and other stakeholders in the workers’ compensation arena often have to confront is “to trust or not to trust.”
When the history of the work injury or illness and the subjective complaints which I get from my patient don’t support the objective findings, I have to wonder about the accuracy of the information. In that situation, asking the patient more questions and getting additional data from the employer is necessary to arrive at a valid, evidence-based opinion. At other times, when the patient isn’t getting better as anticipated, I have to figure out whether it is because of an underlying medical issue which has perhaps not been adequately explored, or whether there are primarily psychosocial barriers to recovery.
Distinguishing between those situations is important, as the treatment plan for the first scenario requires additional medical testing and evaluation, while an effective plan for the second scenario necessitates understanding the social network within which that patient is operating and dealing with the whole person.
In the latter situation, if it is the patient’s lack of coping skills and resilience that present a significant barrier to recovery, and if despite my best efforts, it takes longer to get there than predicted, we arrive at an impasse if the employer and/or payer assume the patient is just exaggerating symptoms for secondary gain. Lack of trust in the treating physician’s clinical judgment and skills might well create (or inflame) an adversarial situation, and the only people who do well in that scenario are the attorneys.
Relationship experts tell us that trust is essential to building strong, positive connections with other people. That holds especially true when trying to establish the therapeutic bond between physician and patient, a bond that is crucial to good outcomes in challenging cases. In the workers’ compensation arena, trust betwixt and between employer, injured worker, payer and physician, though much to be desired, is not always there. Instead, when an employee/patient with a workers’ compensation injury does not get better as quickly as expected, it’s not uncommon to find suspicion, distrust, and finger pointing on all sides.
When the stakeholders do not trust each other to have been acting in good faith, the types of thoughts that are entertained might well include, “If only the doctor wasn’t doing whatever the patient wanted and dragging things out,” or “If only the patient wasn’t trying to milk the system,” or “If only the payer wasn’t putting roadblocks in the way of necessary treatment,” or “If only the employer wasn’t trying to make the patient work outside of the restrictions.” Each stakeholder assumes that since he/she is doing his/her best, someone else must be to blame for the case not going well.
One of the things I have learned in the 22 years I have spent in the workers’ compensation arena is that finding fault with the other stakeholders is not the least bit helpful (despite the fact that righteous indignation can make you feel better for a minute or two). Instead, attempts to determine at whose doorstep the blame appropriately lies usually lead to an even worse outcome. The wagons circle, the hatches are battened, and defensiveness prevails.
When the patient/injured worker is not progressing towards functional restoration as smoothly or as quickly as hoped, what does help is for everyone involved to take a deep breath, realize that we are all on the same team, and make sure we all get on the same page. It is only by finding a way forward and arriving at a solution together, that the physician, patient/employee, employer and payer will be able to help the patient return to work timely and renormalize his life after the disruption of a work injury.
About Dr. Maja Jurisic
After getting a BA with a major in history from Marquette University, Dr. Jurisic went on to Medical School at the University of Wisconsin in Madison, graduating in 1980. She completed an Emergency Medicine Residency at Wright State University in Dayton, Ohio, and was a partner in the emergency medicine group staffing St. Joseph’s Hospital in Milwaukee, Wisconsin from 1983 until 1991. Disenchanted with the endless recycling of social problems in the ER, she was thrilled to discover occupational medicine, where she can make a difference by helping patients renormalize their life after the disruption of a work injury.
She has been with Concentra since 1991. In addition to being board-certified in Emergency Medicine, Dr. Jurisic also became boarded in Occupational Medicine. She is an AVP and serves as the Medical Director for National Accounts at Concentra. She edited Concentra’s Clinician Manual (called Occupational Medicine Redux), as well as contributing 11 of its chapters. She serves on Concentra’s Total Care Medical Expert panel, and is the author of the chapter on patient education in the second edition of Low Back Pain (OEM Press).
Dr. Jurisic is active in the State Medical Society, serving on the Executive Council of the Occupational Medicine Section, and has been appointed by the State of WI Department of Workforce Development to the Healthcare Provider Advisory Committee to the Worker’s Compensation Advisory Council.
Concentra, a subsidiary of Humana Inc., is a national health and well-being organization delivering effective health care solutions with innovative technology platforms, patient-first focus and clinical excellence. As a leader in consumer health care services, the company offers an expansive destination for great medical care with primary and urgent care services, physical therapy, occupational medicine, and preventive care and wellness services. With its exceptional patient experience, more than 330 national medical centers, 270 workplace health clinics and direct-to the patient services, Concentra is improving America’s health, one patient at a time.