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Monday, April 07, 2003Spine specialists have long known that patients with secondary gains — workers' compensation claims or lawsuits — have significantly worse outcomes than those who do not. In fact, in scientific studies designed to judge the efficacy of interventions, investigators must exclude such patients or report their results separately. Of course, such considerations are not limited to spine-related injuries. In a broad sense, Whiplash and Other Useful Illnesses is about the way in which illnesses for which patients may receive compensation are created and sustained for the benefit of a few at the expense of many. Sounds interesting. There’s also this revelation: Malleson draws parallels with other illnesses that were "fashionable" in other periods, such as "railway spine" and "repetitive strain injury," which reached nearly epidemic proportions in other countries until laws allowing compensation were rescinded. After the revocation of these laws, the ailments virtually disappeared. There have been studies that show that injuries take longer to resolve when there are unresolved compensation issues - such as lawsuits and worker’s compensation. And although this is only anecdotal evidence and nothing to base public policy on, I’ve noticed in my practice that patients recover in a matter of days to weeks when they’re the ones at fault, compared to patients who are the victims of accidents, who take months to get better. And the time for recovery does clearly seem to be related to compensation. This is what happens. A person has an accident, and as a result sprains their neck. As in any sprain, the pain is at its worst the first few days, then it gradually gets better. But, even when things are mostly better, there are still, on occasion, twinges of brief pain that come and go. For the person not involved in litigation, these twinges are barely noticed because they’ve moved on. Their injuries are no longer a major focus of their lives. They perceive these twinges as nothing more than the usual aches and pains that everyone suffers now and then. But, the person who is trying to get compensation for their injuries, either through the legal system or the worker’s comp system, has the constant fear that things might get worse. Once they settle the case, that’s it. No future claims will be paid by the other party. So, when they feel those twinges, their inclination is to wonder if they might be harbringers of worse things to come, of disabilities that won't be compensated. That anxiety only serves to magnify the pain. Which keeps the case open. Which costs society a lot of money. The reviewer also throws out this observation from the book: A psychiatrist by training, he particularly faults physicians for publishing poor scientific work in an effort to advertise themselves as experts in the field. This advertising allows them to secure an additional lucrative source of income in the face of a contracting health care market. Now that’s a criticism that could be fairly levelled at a great many researchers these days, and not just in the field of “useful illnesses.” It's a trend against which we should remain forever vigilant. posted by Sydney on 4/07/2003 07:53:00 AM 0 comments 0 Comments: |
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