When does a condition become a medical issue?

 | MEDICAL CONDITIONS  

Doctor shrugging shoulders for article, When does a condition become a medical issue?It has become a sign of legitimacy to call a personal problem “medical.”  This aims to distinguish the problem from those of morality or character.  It implies both that the problem is serious, and that it is unbidden and largely out of the sufferer’s control.  Unfortunately, it isn’t clear what exactly qualifies as “medical,” so this label serves more as a rhetorical device than a scientific finding.

Alcoholism is the paradigm and perhaps least controversial example.  Through the 19th Century, alcoholism was variously declared a disease, or a matter of will and character.  The disease model gained prominence in the 1930s and 40s with the “powerlessness” identified in the 12 Steps of Alcoholics Anonymous, as well as researcher E.M. Jellinek’s descriptions of progressive stages and subtypes of alcoholism.  The American Medical Association declared alcoholism an illness in 1956 and has endorsed the disease model ever since, partly as a strategy to ensure insurance reimbursement for treatment.

The model expanded to include other abused substances with the formation of Narcotics Anonymous in the 1950s, and as a result of widespread recreational drug use in the late 1960s and early 1970s.  The specialty of addiction medicine was first established in 1973 in California.  The American Society of Addiction Medicine now states: “Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry.”  Proponents of the disease model of addiction cite many documented brain changes and a plausible neuropathology, as well as the presence of genetic risk factors, cognitive and emotional changes, impaired executive functioning, and disability and premature death.  The model purportedly destigmatizes addicts — they are no longer “bad” or “weak” people — thereby making it more acceptable for them to seek treatment.

Nonetheless, the disease model of addiction remains controversial.  In addition to the existence of alternative models, the disease model itself has been criticized.  Some believe it removes personal choice and responsibility, and actually contributes to the problem of addiction.  Others cite surveys of American physicians who consider alcoholism more a social or psychological problem — even a “human weakness” — than a disease.  Critics note that about 75 percent of those who recover from alcohol dependence do so without seeking any kind of help, and that the most popular and recommended treatment, Alcoholics Anonymous, is a fellowship and spiritual path, not a medical treatment.

[SEE FULL STORY HERE]

Know Two Types of Functional Capacity Evaluations (FCE)

When a physician is treating an employee for a back injury or other job related injury, the decision on when to return the injured employee to work is often a subjective decision. The physician who is unsure of the employees physical capability will often turn to the physical therapist for an objective opinion of the employees ability for work. The physical therapist will provide a Functional Capacity Evaluation (FCE) by administering various tests to determine the employee’s functional capacities and limitations.

illustration of physical therapist and patient for article, Know Two Types of Functional Capacity Evaluations

Comprehensive Examination and Evaluation

The FCE is a comprehensive examination and evaluation by the physical therapist that objectively measures the employees level of functioning. The testing will document the employees ability, or the lack of ability, to perform the essential job related task over a specific time frame. The FCE will provide objective information to the physician in several areas:

the employee’s functional abilities and job demands

  1. the disability evaluation
  2. when to return the employee to work
  3. whether or not the employee can return to the job held prior to the injury
  4. the employee’s functional abilities away from the job
  5. to information to design a rehabilitation plan, if needed
  6. the need for other medical intervention and/or treatment

    [SEE FULL STORY HERE]

Study finds popular health news stories overstate the evidence

Joy Victoryphoto of Joy Vcitory is Deputy Managing Editor of HealthNewsReview.org. She tweets as @thejoyvictory.

A new study confirms something we here at HealthNewsReview.org have been emphasizing for many years: Health news stories often overstate the evidence from a new study, inaccurately claiming that one thing causes another — as in drinking alcohol might help you live longer, facial exercises may keep your cheeks perky, and that diet soda might be a direct line to dementia.Info graphic of percentage of people who get health info on social media

The researchers looked at the 50 “most-shared academic articles and media articles covering them” in 2015, according to data from the NewsWhip database. Seven of the 50 studies were randomized controlled trials, the gold standard for “causal inference” in medicine (meaning, one can reasonably infer that an intervention caused an outcome, but not always).

The rest were observational studies, which is what it sounds like: Observing people and then seeing what happens to them (or what happened to them, if it’s looking at data collected in the past). They are not true experiments, with a control and placebo group. Sometimes, with lots of observational data–after longterm, repeated findings in thousands of people from different studies that used terrific methodology– the evidence becomes so strong that it can make sense to change public health or medical practice based on only observational data. Smoking and lung cancer is one such case. But it’s also clear that the literature has become littered with poorly done observational studies that make causal claims that cannot be supported.

They found a “large disparity” between what was written in the news stories compared to what the research showed:

  • “44% of the media articles used causal language that was stronger than the academic articles” (and many of those studies were overstated to start with).
  • “58% of the media articles contained at least one substantial inaccuracy about the study.”

X ‘may be caused by’ Y

One way that news stories can overreach is by inaccurately using language that implies x caused y:

  • “may be caused by”
  • “seems to result in”
  • “is caused by”
  • “is due to”

    [SEE FULL STORY HERE]

School System Summer Break – 4 Proactive Work Comp Tips

June 12, 2018 by 

Schools Out for Summer graphic for atricle, School System Summer Break – 4 Proactive Work Comp TipsInterested stakeholders in the workers’ compensation process are constantly seeking ways to reduce program costs.

One area includes the discontinuance of workers’ compensation benefits for school employees and teachers suffering from the effects of a work injury during the summer break period.  While statues and case law interpretations vary in each jurisdiction, employers and insurers are generally limited in their ability to discontinue or suspend various workers’ compensation benefits for school employees during this time of year – even if they have no plans of looking for work while under restrictions on their activity.

Schools Out – Time to Discontinue Work Comp Benefits?

While the school year typically runs from late August through late May, employees of school districts around the country sustain work-related injuries every day.  The ongoing effects of those work injuries do not magically disappear for summer break.  Sadly, those hot summer days a teacher, paraprofessional or administrative staff employee would like to spend at a beach, can be spent at home convalescing.  Proactive members of the claims management team might view this as an opportunity to discontinue ongoing wage loss and vocational rehabilitation benefits.  Unfortunately, this is often not consistent with many state workers’ compensation laws via case law interpretation.

One case on point comes from Minnesota, where a school district sought to discontinue ongoing wage loss benefits at the conclusion of a school year.[1]  The rationale for the discontinuance was based on the premise the employee did not intend to work during the summer months, and the result was no loss in wages.  A compensation judge rejected this argument and affirmed by the Minnesota Workers’ Compensation Court of Appeals.

[SEE FULL STORY HERE]

The Impact of Fatigue and 10 Ways to Mitigate the Risks

If one of your employees is sleeping on the job, he may actually be doing you a favor. Lack of adequate sleep is a major risk factor for injuries, errors, and chronic diseases. In fact, ‘shiftwork sleep disorder’ has been deemed a carcinogen because of the increased risk of breast cancer.

worker fatigue poster for article, The Impact of Fatigue and 10 Ways to Mitigate the RisksThose most at risk are workers with frequent overnight shifts, rotating shifts, or early morning start times. While you may not be able to change the need for workers on shifts other than daytimes, there are strategies you can take that can help employees be less fatigued and save you significant amounts of money.

The Sobering Stats

Employers and payers are likely unaware of the stunning costs associated with workplace fatigue. Here are the numbers for a hypothetical Florida construction company with 800 workers:

 • Decreased productivity: $590,463

• Absenteeism: $249,962

• Healthcare: $458,075

The National Safety Council’s Fatigue Cost Calculator also estimates the number of employees likely suffering from specific sleep risks at this sample company:

• Obstructive sleep apnea: 101

• Insomnia: 69

• Restless Legs Syndrome: 40

• Shift work disorder: 1

‘Shiftwork sleep disorder’ occurs when a person’s internal clock becomes misaligned with his sleep/wake schedule due to shift work. Those affected may experience excessive sleepiness during night work and/or insomnia during daytime sleep.

The good news is the potential savings from taking simple actions to mitigate all these conditions are $625,250.

[SEE FULL STORY HERE]

How to make sure your vacation isn’t a medical disaster

Recently while traveling overseas, I found myself in a predicament not often encountered nor taught to health professionals. I was requested to address an emergency at 30,000 feet in the air. This got us thinking: How many patients consider the possibility of a medical emergency in the air?

photo of person in beach chair with full body cast for article, How to make sure your vacation isn’t a medical disasterPeople with chronic illnesses and the older population (who find themselves retiring and having more time to travel) need to be prepared so their vacation isn’t ruined by a health crisis.

Below are a few tips to stay safe while traveling:

If you have serious medical conditions, be sure your travel companion is prepared to help in case of an emergency. In the event you lose consciousness you need someone to convey information to those on board trained to help you, primarily the flight attendants, or, if you are lucky enough, a medic, emergency medical technicians (EMT), nurse, nurse practitioner (NP), physician assistant (PA) or physician.

This cannot be overstated enough — pack ANY medications you might need in an emergency in a carry-on bag. This includes an epi-pen, albuterol, aspirin, nitroglycerin, antihypertensives, non-steroidal anti-inflammatory medications, insulin, glucose supplement, anti-emetics, oxygen, etc. If you’re not sure if you should carry certain medications on board, discuss it with your primary care physician prior to traveling. TSA states, “Medications in pill or other solid forms must undergo security screening. It is recommended that medication be clearly labeled to facilitate the screening process. Check with state laws regarding prescription medication labels.” Make sure to have plenty of medication for your trip, plan to have your primary care physician call these into the pharmacy at least one week prior to travel. Be prepared for anything. Most airlines only carry a basic first-aid kit, oxygen and a defibrillator.

If you have medical conditions, see if your primary care physician prior to take off for a travel clearance. If your physician detects early warning signs of illness then the risks of travel may far outweigh the benefit.

If you have serious food or environmental allergies (e.g., anaphylaxis — a multi-organ, life-threatening allergic reaction) alert the flight attendants as you board (and have your EpiPen!). Though awareness of serious allergies to peanuts has increased they are still served on some flights. Other commonly served food products include soy and wheat.

[SEE FULL STORY HERE]

3-Step Strategy to Prevent Workplace Violence

June 6, 2018 by 

More than 2 million workers are victims of workplace violence every year. While healthcare clearly leads the industries reporting workplace violence, many other industries are also at risk. Employers and payers can significantly impact the rate of violent incidents by understanding the risks unique to their industries and worksites and developing strategies to mitigate them. 

The Issue

clipboard with violence checklist for article, 3-Step Strategy to Prevent Workplace ViolenceOSHA defines workplace violence as any act or threat of physical violence, harassment, intimidation, or other threatening, disruptive behavior that occurs at the work site. That includes everything from verbal abuse to physical assaults and even homicide.

The most recent statistics show that violence in workplaces is increasing, despite lower overall crime among the general population – including homicides. In healthcare, the numbers are 7.8 cases of workplace violence for every 10,000 employees. In the sales industry, half of the work-related deaths are due to homicide. School districts also report higher rates of violence, aside from the much-publicized mass shootings.

Despite the high prevalence of workplace violence incidents more than 70 percent of U.S. workplaces do not have a formal program or policy that addresses the issue, according to the Bureau of Labor Statistics.

Create the Policy

There are three steps to creating a violence-free workplace.

  1. Assess the risk. First, you need to determine the violence hazards affecting your workforce. They could vary among employees. A healthcare establishment, for example, could have staffers who deal with potentially violent patients in the emergency room, along with nurses in the field. The risks facing each are very different.

ER workers should be aware of potential incidents not only from patients themselves but from family members who may become frustrated. A nurse who conducts home health visits may be vulnerable to risks because she or he is alone. The home health worker should know to ask questions, such as whether there are firearms in the home.

Some ways to assess the risks facing your organization include

  • Find out from staff members whether, where and when they feel threatened.
  • Review past records. Incident reports can reveal areas where violence has occurred, and they should be a focus of prevention policies.
  • Check the research. Studies provide clues to areas vulnerable to violence. Within healthcare facilities, inpatient and acute psychiatric services, geriatric long-term care settings, and urban ERs have been shown to be at higher risk than some other areas.

    [SEE REST OF STORY HERE]

3 Questions to Eliminate Return to Work Disincentives

May 31, 2018 by 

You have implemented a corporate return-to-work program, but your projected workers’ compensation savings haven’t yet materialized. Supervisors are telling you they can’t get employees back to work, and even if they could they don’t WANT them to return to work. We’ve all heard it.

graphic of carrot and stick for article, 3 Questions to Eliminate Return to Work Disincentives It may be time to examine the impact of collateral resources, often resulting in employees out on workers compensation receiving more income and benefits than they would have if they were working.

Common Disincentives to Returning to Work:

  1. Salary and Wage Continuation: Some companies pay 100% of salary in lieu of having an employee collect workers compensation for injuries of short duration.
  2. Occupational Injury Pay Supplements: Many firms pay supplemental benefits to make up the difference between workers compensation benefits and regular earnings.
  3. Open-Ended Job Return: Instead of holding jobs open indefinitely, employers should hold jobs open for a specific time period, such as six or nine months.
  4. Vacation and Sick Time: Companies frequently allow vacation and sick time to accrue for employees on workers compensation. Some even allow employees to “borrow” more sick time if they need to stay out of work longer.
  5. Short-Term Disability: In some companies, disabled employees receive STD benefits in lieu of salary after six weeks. But the standard definition for disability may differ from workers comp, allowing an employee to collect both.
  6. Perk Continuation: Employers often maintain ancillary benefits and privileges such as car allowances, club and professional dues, company store privileges and periodical subscriptions for employees on disability.
  7. Loan Protection Policies: Individual insurance policies are available to pay mortgages and consumer loans such as car loans and credit card debts in the case of a disability.
  8. Unemployment CompensationIn a few states, an employee receiving workers comp also can qualify for state unemployment benefits.

    [SEE FULL STORY HERE]

QuitMedKit: An Essential Guide to Tobacco Cessation App

Douglas Maurer, DO/MPH/FAAFP | 

Tobacco use remains the #1 preventable cause of morbidity and mortality in the United States and worldwide. Overall, cigarette smoking among U.S. adults (aged ≥18 years) declined from 20.9 percent in 2005 to 15.5 percent in 2016. Still, nearly 38 million American adults smoked cigarettes in 2016, according to the Centers for Disease Control and Prevention (CDC).

Screenshot of app for article, QuitMedKit: An Essential Guide to Tobacco Cessation App
And it’s FREE!

Smoking remains the leading cause of cancer, heart disease, stroke, lung diseases, diabetes, and chronic obstructive pulmonary disease (COPD). Efforts to promote tobacco cessation are encouraged at the national, state, local, and individual practice level. The CDC reports only California and Alaska spend the recommended amount on tobacco cessation.

National efforts have included tobacco taxes and smoking bans which have both proven effective. Efforts to prevent the initiation of tobacco use in youths include Tar Wars from the AAFP. More recently, the prescribing of apps for cessation has been utilized and shown to be effective. I have studied the Smartquit app myself via a randomized controlled trial in the military population (unpublished data) served by our residency program. What are the options for providers just wanting to counsel patients outside of a research study and/or paying for a smoking cessation app to prescribe?

The University of Texas MD Anderson Cancer Center has just released a new app called QuitMedGuide. The app was developed by Alexander V. Prokhorov, MD, PhD and Mario Luca, MS, at MD Anderson. The app is intended to assist healthcare providers in counseling and treatment of tobacco dependence. The app includes the evidence-based 5As approach, information on medications for cessation, tips on motivational interviewing, graphics to assist in cessation, and links to online resources.

Evidence-based medicine

Developed by the University of Texas MD Anderson Cancer Center, QuitMedKit uses the current 2008 US Department of Health and Human Services Clinical Practice Guideline for tobacco cessation. The app includes detailed information on the proven 5As approach to cessation, tips on motivational interviewing, and current FDA-approved medications for tobacco cessation.

Who would benefit from this App?

Medical students, primary care physicians, midlevels, hospital medicine physicians, nurses, pharmacists, or any provider who counsels patients on tobacco cessation.

[SEE ORIGINAL STORY HERE]