A Physician's Guide to Return to Work / Edition 1

A Physician's Guide to Return to Work / Edition 1

by James B., Ed. Talmage Ed., J.Mark Melhorn

ISBN-10: 1579476287

ISBN-13: 9781579476281

Pub. Date: 03/01/2005

Publisher: Americam Medical Association

Finally a guide book to help primary care physicians and care providers navigate return-to-work issues. This needed reference is written from the healthcare provider's point of view combining the science with the art of medicine. A Physician's Guide to Return to Work teaches physicians and health care providers how to think through the issues of "risk", "capacity" and


Finally a guide book to help primary care physicians and care providers navigate return-to-work issues. This needed reference is written from the healthcare provider's point of view combining the science with the art of medicine. A Physician's Guide to Return to Work teaches physicians and health care providers how to think through the issues of "risk", "capacity" and "tolerance" when negotiating return-to-work and stay-at-work issues with patients. Highlights of this resource include: A concise compilation of current data The most common questions faced by physicians, insurers, attorneys, employers and workers' compensation managers and answered based on the most current science available Written by practicing physicians and legal experts who regularly face return-to-work issues Delves into the practical aspects of evidence-based medicine, causation analysis, functional capacity evaluations and the legal aspects of return-to-work decision making Ways primary care physicians can help patients negotiate return-to-work decisions Discusses the implications of medication, driving and work The health consequences of unemployment Step-by-step information about specific body systems Specific examples and case studies Tables and charts from the most current edition of The Medical Disability Advisor

Product Details

Americam Medical Association
Publication date:
Product dimensions:
6.00(w) x 8.90(h) x 0.80(d)

Table of Contents

Dedication iii

Preface xi

Acknowledgments xv

About the Editors xvii

Contributors xxi

Chapter 1 Why Staying at Work or Returning to Work Is in the Patient's Best Interest James B. Talmage, MD J. Mark Melhorn, MD 1

Consensus Statements 2

A Review of the Literature 3

Chapter 2 How to Think About Work Ability and Work Restrictions: Risk, Capacity, and Tolerance James B. Talmage, MD J. Mark Melhorn, MD 7

Risk 7

Capacity 9

Tolerance 10

How to Evaluate Work Ability: A Seven-Step Process 14

Summary 15

Chapter 3 How to Negotiate Return to Work J. Mark Melhorn, MD 19

The Return-to-Work Decision Makers 19

Defining Negotiation and Agreement 21

The Five Steps From Injury to Resolution 21

The Time Off Work and Return-to-Work Issue: Lost Work Days 25

Return-to-Work Guides 26

Negotiation Strategies for Return to Work 29

Useful Responses to Three Common Attacks 32

Summary 33

Chapter 4 Return to Work: Forms, Records, and Disclaimers J. Mark Melhorn, MD 39

Communication: The Issues That Should Be Documented in Physician Records 41

Four Screening Tests for Establishing Functional Capacity Guides 44

Establishing Reasonable Functional Capacity Guides or Work Guides 45

Sample Linkage Forms 48

Additional Forms 53

Writing Functional Capacity and Return-to-Work Guides 53

Summary 56

Chapter 5 Evidence-based Medicine Elizabeth Genovese, MD, MBA 59

Study Types 60

Potential Flaws in Study Types 64

Statistical Analysis 65

Analyzing and Applying Study Results 68

Summary 69

Chapter 6 Causation Analysis Elizabeth Genovese, MD, MBA 73

Hill Criteria for Causation Analysis 73

Addressing Causation 76


Causality Determination 78

Summary 80

Chapter 7 Functional Capacity Evaluation: Is It Helpful? David C. Randolph, MD, MPH Trang H. Nguyen, MD Phillip Osborne, MD 83

The Purpose of the Functional Capacity Evaluation 84

The Elements of a Functional Capacity Evaluation 85

Validity and Reliability of the Functional Capacity Evaluation 89

Using a Functional Capacity Evaluation to Make Return-to-Work Recommendations 90

Summary 91

Chapter 8 The Medical and Legal Aspects of Return-to-Work Decision Making Paul F. Waldner, JD Lezzlie E. Hornsby, JD 95

Promoting the Return to Work: The Physician's Responsibility 97

Knowing the Job Requirements and Knowing the Law 98

Some Statutes That Apply to Return-to-Work Determinations 99

Physician Liability in Making Return-to-Work Decisions 107

Summary 111

Chapter 9 Can This Patient Work? A Disability Perspective John L. LoCascio, MD 113

The Disability Decision Maker 115

Defining Disability 115

The Core Idea 115

The Decision Maker in Context 116

The Physician's Role 118

Basic Concepts and Terminology 118

Patient Interview: Defining Pertinent Functional Capacities 121

Estimating Functional Capacity 122

Supporting Symptoms in Excess of Findings 123

Objective and Subjective: Different Issues, Different Tests 124

Dimensions of Consistency 124

Disability Applications and Supporting Medical Data 125

Psychiatric Claims for Disability 125

Examples of Attending Physician Statements 126

Physical Demand Levels from the Dictionary of Occupational Titles 129

Summary 131

Chapter 10 Medications, Driving, and Work Gerald M. Aronoff, MD Michael Erdil, MD Natalie P. Hartenbaum, MD, MPH 133

Magnitude of the Issue 134

Potential Risks 134

Decision Making 137

Specific Medications 139

Summary 144

Chapter 11 How the Primary Care Physician Can Help Patients Negotiate the Return-to-Work/Disability Dilemma Mark D. Pilley, MD 149

Understanding the Role of the Primary Care Physician 149

Avoiding the Impact of Delay 151

Improving Chances for Successful Return to Work: Sample Cases 151

Summary 160

Chapter 12 Working With Common Spine Problems James B. Talmage, MD Robert H. Haralson III, MD, MBA 163

Presumed Disability 163

Lumbar Disk Herniation Resulting in Radiculopathy 165

Mechanical Non-specific Low Back Pain 170

Summary 177

Chapter 13 Working With Common Upper Extremity Problems J. Mark Melhorn, MD 181

Presumed Disability 182

Shoulder: Rotator Cuff Impingement Syndrome 182

Shoulder: Rotator Cuff Tear 187

Elbow: Lateral or Medial Epicondylitis 192

Elbow: Ulnar Nerve Entrapment 195

Wrist: Carpal Tunnel Syndrome 197

Wrist: De Quervain's Tenosynovitis 203

Finger or Thumb: Trigger 205

Nontraumatic Soft-Tissue Disorder 207

Summary 210

Chapter 14 Working With Common Lower Extremity Problems Robert H. Haralson III, MD, MBA 215

Presumed Disability 215

Sprains and Strains 219

Fractures 221

Dislocations 223

Total Joint Arthroplasty 225

Arthroscopic Knee Surgery 228

Summary 229

Chapter 15 Working With Common Cardiopulmonary Problems Mark H. Hyman, MD 233

General Considerations in Cardiopulmonary Assessment 233

Risk in Cardiopulmonary Disease 240

Coronary Artery Disease 240

Hypertension and Hypertensive Heart Disease 254

Reactive Airway Disease/Chronic Obstructive Pulmonary Disease 257

Summary 260

Chapter 16 Working With Common Neurologic Problems Edwin H. Klimek, MD 267

Physician-Certified Absenteeism for Neurologic Illness 267

Neurologic Illness: General 269

Headache 269

Epilepsy 274

Brain Injury 276

Multiple Sclerosis 278

Polyneuropathy 281

Summary 283

Chapter 17 Working With Common Rheumatologic Disorders Yvonne Smallwood Sherrer, MD 289

Nonobjective Factors in Assessing Work Disability 290

Rheumatoid Arthritis 292

Systemic Lupus Erythematosus 295

Osteoarthritis 297

Risk 299

Capacity 300

Tolerance 300

Summary 301

Chapter 18 Working With Common Psychiatric Problems John D. Pro, MD 305

The Problem of Mental Illness in the Workplace 305

Evaluating Mental Impairment 306

Social Security Administration's Criteria for Total Disability 309

Major Depression 311

Pain Syndrome With Medical and Psychological Factors 312

Posttraumatic Stress Disorder 314

Adjustment Disorder 315

Excusing the Patient From Work 317

Initiating Treatment Planning 317

Returning the Patient to Work 318

Summary 319

Chapter 19 Working With Common Functional Syndromes: Fibromyalgia and Chronic Fatigue Syndrome James B. Talmage, MD 321

Social Security Administration's Criteria for Total Disability 322

Risk 322

Capacity 323

Tolerance 323

Summary 324

Chapter 20 The Social Security Administration Disability System Edward B. Holmes, MD, MPH 327

Clarifying Misunderstanding of the Social Security Administration Disability System 327

The Differences Between Impairment and Disability 329

Overview of the Social Security Administration Disability System 330

What the Physician Needs to Know 331

Writing a Medical Source Opinion About Function 334

Weighing of Source Opinions About Function by the Social Security Administration 335

Summary 336

Index 337

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