Abstract
Background Context:
A physician's role within a workers' compensation injury extends far beyond just evaluation and treatment with several socioeconomic and psychological factors at play when compared to similar injuries occurring outside of the workplace. Although workers' compensation statutes vary among states, all have several basic features with the overall goal of returning the injured worker to maximal function in the shortest time period, with the least residual disability and shortest time away from work.
Purpose:
To help physicians unfamiliar with the workers' compensation process accomplish these goals.
Study Design:
Review.
Methods:
Educational review.
Results:
The streamlined review addresses the topics of 1) Why is Workers' Compensation Necessary? 2) What does Workers' Compensation Cover? 3) Progression following Work Injury 4) Impairment and Maximum Medical Improvement (MMI), including how to use the 6th edition of American Medical Association's (AMA) Guides, 5) Completion of Work Injury Claim after Impairment Rating, 6) Independent Medical Evaluation, and 7) Causation.
Conclusions:
In the ‘no-fault’ workers' compensation system, physicians play a key role is progressing the claim along and, more importantly, getting the injured worker back to work as soon as safely possible. Physicians should remain familiar with the workers' compensation process, along with how to properly utilize the AMA Guides.
Abstract
Importance
Silicosis associated with inhalation of respirable crystalline silica among engineered stone countertop fabrication workers is an emerging health concern.
Objective
To describe clinical, socioeconomic, and occupational characteristics of patients diagnosed with silicosis associated with engineered stone in California.
Design, Setting, and Participants
This case series included reported cases of silicosis associated with fabrication of engineered stone countertops, as identified by statewide surveillance by the California Department of Public Health (2019–2022). Data analysis was performed from October 2022 to March 2023.
Exposures
Patient interviews and medical record abstractions were used to assess occupational exposure to respirable crystalline silica, including duration of work tenure and preventive measures undertaken.
Main Outcomes and Measures
Demographics, clinical characteristics, health care utilization, and clinical outcomes were obtained, including vital status, hypoxia, and lung transplant.
Results
This case series identified 52 male patients meeting inclusion criteria; median (IQR) age was 45 (40–49) years, and 51 were Latino immigrants. Ten (19%) were uninsured, and 20 (39%) had restricted-scope Medi-Cal; 25 (48%) presented initially to an emergency department. A delay in diagnosis occurred in 30 (58%) patients, most commonly due to alternative initial diagnoses of bacterial pneumonia (9 [30%]) or tuberculosis (8 [27%]). At diagnosis, 20 (38%) patients had advanced disease (progressive massive fibrosis) with severely or very severely reduced forced expiratory volume in 1 second in 8 (18%) and 5 (11%), respectively. Of the cases, 10 (19%) were fatal; median (IQR) age at death was 46 (38–51) years, and 6 patients (12%) were alive with chronic resting hypoxia. Eleven were referred for lung transplant: 3 underwent transplant with 1 fatality; 7 were declined transplant, with 6 fatalities; and 1 died prior to listing. Median (IQR) work tenure was 15 (10–20) years; 23 (45%) reported use of water suppression for dust mitigation, and 25 (48%) continued to fabricate stone after being diagnosed with silicosis.
Conclusions and Relevance
In this case series performed in California, silicosis associated with occupational exposure to dust from engineered stone primarily occurred among young Latino immigrant men. Many patients presented with severe disease, and some cases were fatal.
Abstract
Independent medical evaluations (IMEs), impairment assessments, and providing clinical care mandate obtaining an appropriate history. The medical interview is a crucial component for obtaining an accurate and complete medical history for IMEs, which requires interpersonal and analytical skills. The interview is a purposeful conversation aimed at understanding the patient's experiences, with a focus on verbal and nonverbal cues, to help build a comprehensive understanding of the patient's injury and current problems within the context of their overall health. The extent of history that is documented depends on the purpose of the evaluation and the nature of the injury. The process involves documenting chief complaints, injury details, pre-existing conditions, clinical course, current symptoms, and functional and past medical history.
Abstract
The inaugural issue of the American Medical Association's (AMA's) Guides Newsletter in 1996 ignited a conversation about the concepts of impairment and disability. Although the AMA Guides to the Evaluation of Permanent Impairment has evolved significantly with evidence-based medicine from the third edition (1990) to the current 2023 version of the sixth edition, conflating impairment and disability ratings continues. Impairment and disability are distinct terms. The extent of an injury does not necessarily predict the effects on activities of daily living, including work, given other clinical factors, comorbidities, motivation, technology, and accommodations. Patients with disabilities are best understood by embracing a biopsychosocial-spiritual model that reflects a humanistic and holistic view because disability is a multifaceted concept that is influenced by evolving physical, psychological, and psychosocial factors. Evaluating impairment is a challenging undertaking and physicians tasked with impairment evaluations must be trained to use the AMA Guides appropriately.
Abstract
Stress can be divided into two types: physical and mental. This review focuses only on mental and/or psychological stress and two types of cardiovascular problems—coronary artery disease and hypertension—because they are the two most commonly encountered cardiovascular diseases requiring an impairment evaluation. This information can serve as a paradigm for other cardiovascular disorders.
Abstract
Artificial intelligence (AI) is transforming healthcare and holds immense potential for the medicolegal field. It also presents significant challenges for these systems and their participants. This article overviews core AI concepts such as machine learning and large language models. It highlights current medical applications spanning clinical decision support, computer vision, robotics, and predictive analytics. AI can aid research, summarize documents, draft reports, and enhance quality and efficiency in a medicolegal practice. Limitations must be recognized and managed. Human expertise remains irreplaceable for nuanced analysis, and oversight is crucial. With thoughtful adoption, AI can augment medicolegal evaluations and enhance quality and efficiency. But human skills like critical thinking, judgment, and compassion must persist at the heart of this profoundly human profession.
