Commentary From CareWorks Medical Director Dr. Chrisanne Gordon, MD
The Management of Disability & the Prediction of Healing
In today’s workers’ compensation world, management of disability (MOD), is quite the buzzword. Physicians, nurses, case managers, human resources personnel at the MCO and BWC as well as Physician of Record offices are all working on the process of allowing injured workers to journey from illness or injury to healing and ultimately a healthy and safe return-to-work.
This is a detailed process involving medical and administrative personnel and legal services as well. Through the process, one common thread remains - the human body is built to heal. Amazing, right? All too often we forget this incredibly important aspect of injury care, that the body is an amazing healing machine with remarkably reproducible statistics.
We know the following from centuries of research on the human condition:
- A bone fracture, for the most part, will heal in about 4-6 weeks for the vast majority of humans. Professional athletes and young able-bodied adolescents can heal quicker than older patients or those with underlying medical conditions. That is why we have an “average” healing time of about six weeks. It is a very good gauge for health care providers, employers and injured workers to support a frame of reference for “return to normal.”
- A simple muscle or tendon sprain, like a fracture, can take about 4-6 weeks to heal, whereas more complex sprains or tears can take up to 8-10 weeks. The healing process is at first directed to rest and then directed to gradual return to function.
- A ligament strain can take 12-16 weeks to heal, such as a strain in posterior spinal ligaments which can lead to bulging or herniated discs.
- A nerve injury heals at the rate of about one inch of repair a month, so the longer the nerve the longer the recovery.
The consistency in the human body for healing is standard and if the recovery process takes longer than normal there are variables to be considered. These variables to be considered are, at the very least, listed below:
It is not discrimination to understand that as the human body ages, often through chronic wear and tear issues regarding joints, muscles, tendons and even nerves. The ability to self-repair decreases as one’s DNA synthesis and repair abilities also decrease. Bones that are more brittle; or osteoporotic; tendons that are frayed; ligaments that have been pulled and stretched through life all make the recovery of an aging person, for the most part, longer and more expensive to support.
- Underlying Health Issues
Diabetes, obesity/metabolic syndrome and vascular diseases, in particular, can hinder the healing process and prolong recovery time. All of these conditions increase in incidence with increasing age.
To physicians, the worst habit for healing is of course smoking, which causes small blood vessel disease and therefore impairs circulation. Without proper blood flow the delivery of oxygen and nutrients necessary for healing is greatly impaired, thereby increasing healing times and complication rates. Infection, skin breakdown, non-union of fractures can all occur with smoking. A close second would be alcohol consumption, which can affect nerve cells in particular and overall health in general. The opiate addiction situation is rampant as well and will be the topic of its own discussion in the near future.
- Job Responsibilities/Activities
The possibility of light duty is important to maintain work activities and connection with the workforce. It stands to reason that a person whose job requirements are less strenuous, such as a desk IT position, could return-to-work prior to a very strenuous job requiring heavy lifting, walking or standing for long periods of time.
All of these factors go into the management of disability process. All of us involved in this process need to be on the same page regarding safe return-to-work to offer the best plan for gainful employment and lifestyle stability for each injured worker.
In subsequent newsletters, we will outline how CareWorks’ review process accomplishes this goal by gathering all of the data necessary to make the best determination for the injured worker, which is, of course, the best option for the employer as well.
Healing is constant. Opportunities to heal are variable. We work with the variables from the date of injury to encourage the best possible outcomes for each injured worker.
Dr. Chrisanne Gordon, MD
CareWorks Medical Director
Chrisanne Gordon, MD received her Doctor of Medicine in 1977 from The Ohio State University where she graduated with honors, Summa Cum Laude. Dr. Gordon trained at The Ohio State University in the Internal Medicine Department. After her internship and residency, Dr. Gordon practiced for four years as an emergency room physician. In 1983, Dr. Gordon became the Director of the Occupational Health Center for Memorial Hospital of Union County in Marysville, Ohio. She completed her residency in Physical Medicine and Rehabilitation from The Ohio State University Hospitals. Since 1988 she has been the Director of Physical Medicine at Memorial Hospital of Union County.
Dr. Gordon obtained Board Certification in 1989 by the American Board of Physical Medicine and Rehabilitation. She has been in private practice in the area of Physical Medicine and Rehabilitation in Columbus and Marysville Ohio from 1988 to present. She has also served as CareWorks Medical Director since 1997. Due to the majority of injuries in workers’ compensation being musculoskeletal in nature, her area of expertise is invaluable to providing direction on medical treatment for the population that is served. Her role and responsibilities include:
- Assisting with the development and quality assurance of policies and procedures for medical management and return to work services;
- Developing medical policy and utilization review criteria;
- Evaluating utilization and provider practice patterns;
- Overseeing clinical decision-making aspects of the medical management program;
- Overseeing the CareWorks’ Alternative Dispute Resolution (ADR) process and panel of ADR physician reviewers/examiners; and,
- Having periodic consultation with practitioners in the field.