Worsening Prognosis with Time Off of Work

It is well documented in several studies that the chance of ever returning to work dramatically decreases the longer a person is off from work.  Dr. Gordon Waddell showed in the 1980’s that if a worker is off from work for a year, the chance of ever returning to work is less than 20%.  By two years, the chances are even lower.

As a young resident and surgeon, I always assumed that this group of people were the kinds of people who did not want to go back to work.  It became somewhat of a self-fulfilling prophecy in that I would not put in as much effort to work with them because “they weren’t motivated,” so what could I do to change that mindset?  I did not have any inkling as to how much suffering they were really experiencing.  I feel that even with all of the work I have done with injured workers that I am just now beginning to fathom the depths of despair that my patients have descended into.  I call this pit of despair the “abyss.”

A problem for most injured workers is the the overkill response to malingering, which is around 5-10 percent.  Instead of setting up the system to help the 90% who want a normal life back, resources are directed at identifying and trying to stop the malingering.  It is a big problem.  Unfortunately, most physicians have been burned by this group, which also influences how they care for injured workers.

I now see that the vast majority of injured workers’ dreams are not to be disabled.  It is a basic human need to feel like we are making a contribution to our families, society, and the world.  The reason injured workers do not go back to work is because they are trapped.  Here is a  list some of the reasons for this, though I realize that there are infinitely more:

  • Claim difficult to open or disputed
  • Management of the claim is in the hands of non-medical personal
    • This one makes me completely crazy
  • The system is an amorphous object—it cannot and will not respond to your individual needs
  • Expectations are continually dashed
    • Retraining
    • Basic care
  • No direction or plan
  • No one really listens to you, much less believes you

If you are a worker’s comp patient reading this, I bet your blood pressure is already a little up just being reminded of the continual degradation to you as a person.

When you are trapped, the resultant emotion is anger.  Anger is both the turbo-charger that drives your anxiety-producing thoughts and the anchor that holds you back.  You are now trapped by both your circumstances and your racing thoughts.  The place you go to in your mind can be very dark, and I don’t think it is easily helped by the medical profession.  You may not even be aware how dark that place is.

As the anger keeps your nervous system hyper-sensitized, you continue to experience more pain and more frustration.

How are you going to return to work and a normal life in the middle of all of this chaos?

BF