The Intersection of Medicine and Disability
Marcos Iglesias
Search for other papers by Marcos Iglesias in
Current site
Google Scholar
PubMed
Close
Restricted access

Abstract

Many physicians were not formally trained in the evaluation and management of disability and must understand the language of disability, how disability is evaluated, what to expect from a medical evaluation, and how to communicate effectively to achieve the best outcomes. The very language of disability is complex and often is misunderstood. For example, the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Sixth Edition, defines impairment as “a significant deviation, loss, or loss of use of any body structure or body function in an individual with a health condition, disorder, or disease.” In contrast, disability is variously defined by the administrative or legal system with jurisdiction, and the AMA Guides broadly defines disability as “activity limitations and/or participation restrictions in an individual with a health condition, disorder, or disease.” Another useful concept is “needless disability” or days away from work that are not medically necessary; workless populations experience a two- to threefold increased risk of poor general health, including higher rates of cardiovascular disease, lung cancer, and respiratory infections, among other problems that contribute to an excess mortality of 20% among individuals in this group. Physicians help establish but are not the final arbiters of disability determinations; their role is to provide accurate, complete, and clear information that allows others to determine the presence, extent, and compensability of disability.

  • 1.

    Federal Employees Compensation Act; Federal Employers Liability Act; Longshore and Harbor Workers' Compensation Act; Jones Act (Merchant Marine Act). The Federal Black Lung Program specifically deals with workers who develop pneumoconiosis as a result of mining coal.

  • 2.

    Holder KA. The Disability of Veterans. Washington, DC: US Census Bureau, 2016.

  • 3.

    US Census Bureau. News release: Nearly 1 in 5 people have a disability in the U.S., Census Bureau reports. July 25, 2012. https://www.census.gov/newsroom/releases/archives/miscellaneous/cb12-134.html. Accessed Dec. 5, 2017.

    • Search Google Scholar
    • Export Citation
  • 4.

    A person with a disability “is one who is unable to perform one or more activities of daily living; has one or more specific disabilities; or is a long-term user of assistive devices such as wheelchairs, crutches, and walkers.” Source: National Service Inclusion Project. Basic Facts: People with Disabilities. http://www.serviceandinclusion.org/index.php?page=basic. Accessed Dec. 5, 2017.

  • 5.

    Roy A. How Americans game the $200 billion-a-year “disability-industrial complex.” Forbes, Apr. 8, 2013.

  • 6.

    Social Security Administration. Annual Statistical Report on the Social Security Disability Insurance Program, 2016. Washington, DC: Social Security Administration, 2017. SSA Publication No. 13-11826.

    • Search Google Scholar
    • Export Citation
  • 7.

    Autor DH, Duggan MG. The Growth in the Social Security Disability Rolls: A Fiscal Crisis Unfolding. Journal of Economic Perspectives. 2006;20(3):7196.

    • Search Google Scholar
    • Export Citation
  • 8.

    Joffe-Walt C. Unfit for work: The startling rise of disability in America. National Public Radio. 2013. http://apps.npr.org/unfit-for-work/ Accessed Aug. 8, 2018.

    • Search Google Scholar
    • Export Citation
  • 9.

    Rondinelli RD, Genovese E, Katz RT; AMA Guides to the Evaluation of Permanent Impairment. 6th ed. Chicago, IL: American Medical Association, 2008.

    • Search Google Scholar
    • Export Citation
  • 10.

    US Department of Justice. A Guide to Disability Rights Laws. Washington, DC: US Department of Justice, 2009.

  • 11.

    Social Security Administration. Disability Evaluation Under Social Security. Part I – General Information. https://www.ssa.gov/disability/professionals/bluebook/general-info.htm. Accessed Aug. 8, 2018.

    • Search Google Scholar
    • Export Citation
  • 12.

    Jurisic M, Bean M, Harbaugh J, et al.The personal physician's role in helping patients with medical conditions stay at work or return to work. J Occ Env Med. 2017; 59(6):e125e131.

    • Search Google Scholar
    • Export Citation
  • 13.

    See, for example, Iglesias MA. Worklessness may be dangerous to your health. 2016. https://www.linkedin.com/pulse/worklessnessmay-dangerous-your-health-marcos/; 2016. Also see, Jin RL, Shah CP, Svoboda TJ. The impact of unemployment on health: a review of the evidence. Can Med Assoc J. 1995; 153:529540, and Waddell G, Burton AK. Is Work Good for Your Health and Well-Being? London: The Stationery Office, 2006.

    • Search Google Scholar
    • Export Citation
  • 14.

    Washington Department of Labor and Industries, 2013. Published in IAIABC Disability Management and Return to Work Committee. Return to Work: A foundational approach to return to function. April 19, 2016. Available at https://www.iaiabc.org/images/iaiabc/Return-to-Work_Foundational-Approach-to-Return-to-Function_Final.pdf

    • Search Google Scholar
    • Export Citation
  • 15.

    Pransky G, Katz JN, Benjamin K, Himmelstein J. Improving the physician role in evaluating work ability and managing disability: a survey of primary care practitioners. Disabil Rehabil. 2002; 24:867874.

    • Search Google Scholar
    • Export Citation
  • 16.

    Barron BA. Disability certifications in adult workers: a practical approach. Am Fam Physician. 2001; 64:15791586.

  • 17.

    Wrapson W, Mewse AJ. Does the doctor or the patient control sick leave certification? A qualitative study interpreting patients' interview dialogue. Family Practice. 2011; 28:202209.

    • Search Google Scholar
    • Export Citation
  • 18.

    Söderberg E, Alexanderson K. Sickness certification practices of physicians: a review of the literature. Scand J Public Health. 2003; 31(6):460474.

    • Search Google Scholar
    • Export Citation
  • 19.

    Pransky, 2002.

  • 20.

    Zinn W, Furutani N. Physician perspectives on the ethical aspects of disability determination. J Gen Intern Med. 1996; 11(9):525532.

  • 21.

    Talmage JB. Failure to communicate: how terminology and forms confuse the work ability/disability evaluation process. J Insur Med. 2007; 39:192198.

    • Search Google Scholar
    • Export Citation
  • 22.

    Talmage JB, Melhorn JM, Hyman MH: AMA Guides® to the Evaluation of Work Ability and Return to Work. American Medical Association, 2011.

    • Search Google Scholar
    • Export Citation
All Time Past Year Past 30 Days
Abstract Views 89 89 15
Full Text Views 26 26 0
PDF Downloads 0 0 0
Save