Delayed Recovery Part 2 – Risk Assessment & Interventions

In this episode of Fit for Duty, Dr. Larry Earl hosts Dr. Diana Kramer to continue the discussion on delayed recovery in workers compensation cases, focusing on the biopsychosocial model.

They explore its role in addressing the comprehensive health of workers beyond just the physical injury, emphasizing the importance of work in the healing process. Key concepts such as the 80-20 model, resilience, and the significance of a correct diagnosis are discussed, alongside the impact of mental and social factors on recovery.

The conversation also highlights how technology can improve personalized treatment and the overall system. The episode further delves into practical strategies for early intervention, assessing and addressing social aspects impacting recovery, the physician’s role in navigating these challenges, and the significance of collaboration with workplaces.

To wrap up, they discuss how big data and evidence-based medicine can advance the workers’ compensation system to better manage delayed recovery, unnecessary disability, and high-risk payouts, aiming for a holistic approach to worker health and wellness.

Key Topics:

* Deep Dive into the Biopsychosocial Model

* Exploring Key Concepts: Resiliency, Return to Work, and Diagnosis

* Interventions and Strategies for Occupational Health

* Addressing Social Aspects and Recovery in Occupational Health

* Leveraging Technology and System Improvements for Better Outcomes

* Concluding Thoughts on Occupational Health and Recovery

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Transcript

[00:00:00] host: Greetings and welcome to Fit for Duty. I'm Dr. Larry Earl, your host and president of the National Association of Occupational Health Professionals. Today, we'll explore the world of occupational health, unraveling the complexities of [00:00:20] OSHA regulated exams, workers compensation cases, drug testing, and injury care strategies.

[00:00:26] host: We'll also examine prevention strategies, total person health analytics and interventions, discussing innovative approaches to preventing workplace injuries and illnesses, using total person health analytics to [00:00:40] identify underlying factors contributing to workplace health issues, and showcasing successful interventions that have improved employee health and well being.

[00:00:49] host: Fit for Duty provides a holistic approach to occupational health, empowering organizations to create healthier, more productive workplaces. Join us as we push the [00:01:00] boundaries, break down silos, and bridge theory and practice.

[00:01:07] host: Welcome back to Fit for Duty. In part one of our discussion with Dr. Diana Kramer, we began exploring delayed recovery in workers compensation. Today, we're focusing on the [00:01:20] biopsychosocial model, an approach that considers the worker's whole life, not just the physical injury. We'll discuss the surprising role of work in healing.

[00:01:29] host: Why getting the right diagnosis is crucial and how mental and social factors can impact recovery. Plus, Dr. Kramer will share how technology [00:01:40] can help us personalize treatment and make the entire system work better for everyone. Let's get started.

[00:01:52] host: Welcome back to this fit for duty episode. This is part two of delayed recovery and workers comp cases with our special [00:02:00] guest, Dr. Diana Kramer. Good morning.

[00:02:03] guest: Good morning. Nice to have you back. How are you this morning?

[00:02:05] host: Hey, you know, last time we talked about collectively making this transition from the medical model of workers compensation injury care to the biopsychosocial model.

[00:02:17] host: And you mentioned a few terms that I want you just to [00:02:20] give me a quick one liner, top of mind about. 80 20 what does that mean? 80

[00:02:26] guest: 20 is the concept that 80 percent of our workers go back to work and it's only 20 percent it's the outliers essentially that cause the work and the [00:02:40] burden to the, uh, to the system.

[00:02:42] host: Resiliency.

[00:02:44] guest: Resiliency is the concept that we all meet adversity every day. We grow from adversity. We [00:03:00] remember, the way I like to say this the most, is if we remembered every bad thing that ever happened to us, we probably wouldn't get out of bed. And therefore, we incorporate our past learning experiences into the person we become going forward, and that can [00:03:20] lead to a sense of growth or a sense of stagnation.

[00:03:23] guest: Wow.

[00:03:24] host: Great, great definition. I don't think I've heard it put quite like that. Wonderful. Return to work is good for you.

[00:03:32] guest: If we don't work, we lose a part of our social identity. When you're at a party, one of the first things that [00:03:40] happens is what do you do? When we don't work, our medical core morbidities go up, our income goes down, our quality of life goes down, and we die earlier. So as we are, Advocating for our patients, one of [00:04:00] the things we need to do is consider that part of our medical treatment is returning that person back to work.

[00:04:07] guest: It is good for them.

[00:04:09] host: That's one of the vital signs for workers competition. Are you working?

[00:04:16] guest: Yes. Exactly.

[00:04:17] host: Uh, biopsychosocial model does not take [00:04:20] more time, but different time.

[00:04:23] guest: Yes. You and I, as treating physicians, are in the records. We are in the records. We're looking at past medical history. We're looking at allergies.

[00:04:32] guest: There are other clues in those records. This does not require more time reviewing the records. It [00:04:40] requires time. different time and different focus. What are the comorbidities? What's the educational level? What are the, are there multiple other contested, uh, claims? Is there a history of this person who's had prior injuries that has delayed recovery?

[00:04:58] guest: Takes a year or two years to [00:05:00] recover from something that, would typically not take that long. Those clues are in that medical record and we're in that medical record anyways. This is a matter to some extent of, of enlarging our scope, our horizon, our radar.

[00:05:19] host: Seek the [00:05:20] correct diagnosis.

[00:05:24] host: That doesn't sound like it should be difficult.

[00:05:25] guest: If I don't make It, it doesn't, but if you think of the science there, somewhere between 10 and 20 percent of the diagnoses that you and I make every day are incorrect or marginally correct. [00:05:40] And I think as part of our medical honesty, we need to keep reconsidering what is correct.

[00:05:51] guest: The diagnosis is, for example, and we need to not accept a diagnosis being sent to us. So I think that critical thinking is part of [00:06:00] who we need to be. And the reason I think this is important is that if we don't make the correct diagnosis, it's not clear to me how we're going to treat that person. Part of the diagnosis Does, has to do with the mechanism of injury and the causation [00:06:20] around that event.

[00:06:21] guest: So if we are ascribing something to an injury, for example, that may be, part of normal aging, uh, then we may be creating, a conflict. So last time we spoke, I gave the example of, bilateral imaging [00:06:40] findings. If we have a worker who comes in with repetitive overhead work and we get an MRI on one shoulder and there's a rotator cuff tear and the person's 50, I think we need to consider that the other shoulder probably looks the same.

[00:06:58] guest: The other knee probably [00:07:00] looks the same. That our treatment paradigms. So, I think part of the diagnosis has to do, you may make the correct diagnosis, but you may not necessarily make the correct causal inference, and if you treat a degenerative rotator cuff as just [00:07:20] an injury, you may be doing your patient a disservice.

[00:07:25] host: And I think that handles the next item, context of causation analysis. So, uh, let's move on. Listening to our patient does not equal relying on self report.

[00:07:34] guest: One of the things, and we talked about this last time, is, that it is healthy for [00:07:40] us to forget our past infirmities. When a person comes in, As our patient and tells us something, it's important for us to understand that past context that it's healthy to forget and therefore what the person says to us needs to be [00:08:00] accepted, may not need to be accepted at face value, and may be worthwhile putting within the context of causal inference and perceived injustice and other biopsychosocial models.[00:08:20]

[00:08:20] host: And I like this last one balance fear of missing something with the fear of over treating. I love this one.

[00:08:29] guest: It is easy in a patient in physician interaction To want to do the right thing [00:08:40] that is it's intrinsic to who we are as physicians What if the right thing is? Not getting another test What if the right thing is not adhering to the biomedical model where all, uh, pain and suffering is ascribed to [00:09:00] a medical model and instead we expand our thinking to the biopsychosocial model.

[00:09:07] guest: So rather than potentially in the absence of red flags or even yellow flags, we redirect, I'm not going to say push back because when you've got a patient who's looking at you saying, why aren't you doing that MRI, [00:09:20] weren't you doing. Another MRI. I think the question needs to be maybe to even preempt the request to go on to more testing and go to more functional outcome and a part of that has to be the concept of [00:09:40] accepting the That the goal may not be cure of pain, but the focus needs to be on function.

[00:09:52] guest: And it doesn't mean we ignore the pain, but what we need to do is get out of the biomedical model where we're going to fix it, [00:10:00] get into the bio-psychosocial model of how we're going to contain, uh, modify. And grow the person into a new sense of self accomplishment and agency.

[00:10:13] host: So a surgeon is telling us not to look for things that we can fix [00:10:20] surgically.

[00:10:21] guest: Yes.

[00:10:22] host: Kind of. The

[00:10:22] guest: only thing worse than a person who has low back pain is a person who's head is Low back surgery. It has low back

[00:10:29] host: pain. Yeah. Very good. Okay. So that recaps our previous discussion. Thank you for those insights. Now we're going to move into interventions, [00:10:40] proactive interventions. So, tell us what are some early intervention strategies that you recommend for preventing delayed recovery and promoting timely recovery in work related injury cases.

[00:10:56] guest: Yeah, thank you. I'm so glad you asked. [00:11:00] We, let's go back to that. Let's go back to the 80 20 model. we are looking at that 20 percent and I think it's important to realize we're not gonna, we're not gonna, Capture that entire 20%. But there are patients who are gonna walk into our office that are at RI risk for [00:11:20] delayed recovery.

[00:11:21] guest: And maybe it's 2%, maybe it's 5% of the people that we see. I think one of the ways to. have success in accepting and in achieving these goals is to start little and grow. So the first thing we want to do is we want to embrace the [00:11:40] biopsychosocial model. We think in the biopsychosocial model, we just don't realize it.

[00:11:44] guest: when a person walks into our office and they're depressed, we are automatically in the biopsychosocial model. I think we just need to embrace that the disease we're looking at is within a person and that is helpful to us in [00:12:00] terms of what we started out to do, which was to treat people, help people.

[00:12:06] guest: And it's going to bring to our day, a sense of relief and a sense of healing. I like to think that this decrease, decreases burnout because now [00:12:20] we're thinking about things differently and in the middle of a crazy busy day, instead of just walking in and looking at the person who's back in our office who hasn't gotten better.

[00:12:31] guest: maybe it's as simple as. I sent you for physical therapy, show me one of your, show me your [00:12:40] exercises, show me two or three of your exercises. And if I can do my IYTs. Then, and it takes 30 seconds, then I know that person is compliant with therapy. If the person says, well, I stretch, does mean, are they compliant with my therapy?

[00:12:58] guest: That takes [00:13:00] essentially no more time. It's just a reconstruct of the, of the, of the, the biomedical model to the biopsychosocial. So, first of all, it is embracing the biopsychosocial model, which is intrinsically supportive, and helps our identity as physicians. [00:13:20] The second is to learn. We need to learn This entire field of medicine that we weren't taught in medical school, and that is how do you, how do you embrace, how do you learn about the biopsychosocial model?

[00:13:34] guest: How do you learn about causation? How do you incorporate those into [00:13:40] your, into your practice? Who's going to teach you? Who's going to mentor you? And I think the third part of this, as clinicians, the first things we can do as clinicians today or tomorrow is accept the concept of free will, that there are patients where we're going to be able to intervene, and there are [00:14:00] patients where we're not.

[00:14:01] guest: And we don't need to accept the world. We understand already that some of our patients are going to die. to have failed recovery and what, or delayed recovery. And what I'm recommending is we recognize those people who, are at risk, [00:14:20] but still their course can be modified. That's where we're going to succeed.

[00:14:27] guest: And as we succeed, we'll be rewarded. And as we're rewarded, we'll grow.

[00:14:34] host: Kind of leads into the second question that we had, uh, how can healthcare providers [00:14:40] effectively assess and address. social aspects that impact recovery. You mentioned we don't really get trained to do this. So, how do we look at these workplace dynamics and support systems and what's the approach?

[00:14:54] guest: Yes, I agree. So, we've already talked about the big ones. Recognize the [00:15:00] worker at risk for delayed recovery. Integrate the psychosocial context at the beginning of our treatment. For example, if somebody has low back pain and they come in and they're not sleeping, we need to resist the concept that, well, you're not sleeping is not part of your claim.

[00:15:17] guest: It's part of your general medical. And therefore [00:15:20] I'm not going to treat it. It can be as simple as You're not sleeping. Here, we need you to do some sleep hygiene. You need to turn off your TV. You need to have your screens out of your room. And I'm going to give you an extra dose of gabapentin at night because gabap you say gabapentin makes you drowsy.

[00:15:39] guest: [00:15:40] Great. Let's use it at night. So instead of taking 300 at night, you're going to take 600 or 900. It may be something as simple as that, essentially very little more time, or less time because you're not dealing with the negative and you've created, you're listening to the person and you're creating a dynamic of shared [00:16:00] interaction and shared decision making.

[00:16:04] guest: The other things I can, getting back to that accurate diagnosis, early appropriate testing and then feeling confident in your diagnosis. Doesn't mean arrogant, means confident. Then as you're dealing with that person, [00:16:20] regularly, you can watch for escalation of symptoms, screen for risk factors.

[00:16:24] guest: What are the risk factors for delayed recovery? Older age, lower education, going back to a high intensity job, high physical activity, activity. Those are red flags. So if we start to see that [00:16:40] expansion or escalation of symptoms, and now it's not only the low back, but it's the shoulder, or it's the one arm, and now it's the other arm.

[00:16:52] guest: Those are red flags for delayed recovery. It doesn't necessarily, they can be red flags for medical care, but if [00:17:00] we're, for medical conditions, but if we're thinking in the biopsychosocial model, we can decrease unnecessary testing potentially by focusing on whether or not that escalation of symptoms is consistent with the diagnosis.

[00:17:18] guest: Maybe the diagnosis has to [00:17:20] change or maybe it's simply it's It's an escalation and it's a risk factor.

[00:17:28] host: Yeah, very good.

[00:17:30] guest: The next thing I would, the next thing I would recommend, and these are just proactive, is this whole concept of avoidance. we talked about [00:17:40] rice, rest, and now we need to talk about mice, motion, and maybe motivation, and we need to address those.

[00:17:48] guest: We need to set expectations. It's, we, I need you moving. Yes, it hurts. It's safe. We've checked. You don't have a, you are not going to hurt yourself by work, by [00:18:00] moving. Yes, it'll hurt at first. Physical therapy hurts at first. and then set expectations about return to work. and I'm going to talk in a minute about risk, capacity and tolerance and what that means in terms of our conversations with our patients.

[00:18:17] host: Yeah, let's move into that. Uh, [00:18:20] the physician's role in addressing social aspects that impact recovery.

[00:18:26] guest: Let's start, let's, yes, let's talk first about, return to work, risk, capacity, and tolerance. Now, me talking about risk, capacity, and tolerance to a group of occupational medicine physicians may be bringing Kohl's [00:18:40] to Newcastle.

[00:18:41] guest: But what we do as physicians is you and I speak in terms of risk and capacity, and our patients are talking to us about tolerance, because they don't know what the medical risks are of them doing a task. They don't know about their capacity. So what [00:19:00] our. patient is talking to us about is, I can't do this, or I'm afraid, or I can't, go back to work.

[00:19:08] guest: Well, why not? Okay. As a physician, we're talking about risk. Is it safe for you to go back to material handling? that is [00:19:20] risk. If you have epilepsy, can I approve you for a commercial driver's license, right, license? No. Okay. That is an absolute restriction. As opposed to limitations, capacity is the concept that, You're injured, Larry.

[00:19:38] guest: You have been [00:19:40] inactive. Your capacity may be diminished from your typical work activities. How am I going to set limitations and get you back into the workplace as we get you better? And the patient's talking in terms of tolerance. I hurt. I can't do that job. [00:20:00] Well, getting back to the concept of we're not going to cure your pain, we're going to reduce your pain, and we're going to focus on function.

[00:20:09] guest: We end up in the clinical setting in a negotiating stance with our, with our patients as to trying to get them from a tolerance [00:20:20] model to a capacity model.

[00:20:25] host: Yeah, I think, I think that's true, but I think a lot of front line providers seeing the patients for the first time really struggle with that concept between risk and capacity.

[00:20:36] host: They often may not have a full [00:20:40] appreciation of what the capacity is to get back to a modified or transitional duty role.

[00:20:48] guest: Yes, and how many times have you heard your patients say they don't want me back at work till I'm 100%? So not only we're doing this, [00:21:00] capacity evaluation in our office, we're also doing it within a different set of psychosocial, social construct, which is the workplace.

[00:21:09] guest: Yeah,

[00:21:10] host: yeah.

[00:21:11] guest: This is where

[00:21:14] host: go

[00:21:14] guest: ahead.

[00:21:15] host: Well, I think, just keying off of your, uh, your thought there, that oftentimes [00:21:20] patients will tell us that, but it's from within themselves. if you talk to the supervisor or the The plant manager and you say, hey, we've got these modified duties in mind for this individual.

[00:21:32] host: Oh, yeah, we can do that. The patient doesn't often know that that's even available. So [00:21:40] maybe that gets into my next question, you know, collaborating with the workplace to make sure that we can address these issues.

[00:21:49] guest: Bingo. there's only so much you and I can do in the office. And at some point, this is a systems issue and it's a huge systems issue.

[00:21:56] guest: And as you know, anybody who does workers comp understands there's [00:22:00] a massive, bureaucracy, administrative burden to, uh, The entire system, but if we keep in mind that returning the worker to work is in everybody's best interest, it's in the worker's best interest, it's in the company's best interest, the [00:22:20] employer's best interest, it's in the insurance company's best interest, when we get workers back to work.

[00:22:26] guest: it costs the system less, it's better for the worker, and it improves productivity. So it's no longer a drain. Now we need help in this. So what we need are worker activation [00:22:40] programs, whether it's stay at work, return to work. We need case management systems to help us identify when we've identified these people who are at risk for delayed recovery.

[00:22:53] guest: How do we activate? Uh, someone, uh, a case manager to help us interact with the, [00:23:00] with the employer. This caseworker does not necessarily need to be a medical person. It's more important that the person have communication skills, skills with conflict resolution, and a knowledge of job accommodation. This whole concept of, and also.

[00:23:18] guest: Avoiding [00:23:20] isolation, maintaining an integration as simple as within the workplace during early, early phases of injury, keeping that person as simple as keeping that person in context with their, with the cohorts that they like, potentially keeping them involved, maybe getting them in to [00:23:40] some minimal activity, having someone from the workplace, call them and Even as simple as, how are you doing, what can we do to help?

[00:23:49] guest: Those minimal interactions can make a huge difference.

[00:23:54] host: Very good. How can we improve the accuracy and effectiveness [00:24:00] of risk assessments to better predict and proactively address potential challenges in individual cases?

[00:24:08] guest: So we know, that we are going to have people with delayed and failed recovery. it is intrinsic to the system.

[00:24:15] guest: It has a known incidence, it can be expected and anticipated. [00:24:20] We need models of risk stratification, and this has to do not necessarily, so for an individual, we need a system of identifying risks within that person, so we need, we need Uh, moderate to high risk of delayed recovery and there's an entire system for doing that.

[00:24:39] guest: I'll [00:24:40] talk about that next. We need to intervene early and it's cost effective. We need stepped care models for this person. We need health, it can be as simple, early on, health education, health cognitions, self efficacy and shared decision making. Those are, you know, entry [00:25:00] level, interventions. Larger ones, de stigmatizing, uh, such things as cognitive and behavioral treatments, um, which is a huge burden and needs to be done in a stepwise fashion because, for example, we don't, the [00:25:20] insurance company is not going to want to accept it.

[00:25:24] guest: a lifelong psychiatric issue. But let's start short of psychiatric issues. Let's talk about CBT for pain avoidance, for [00:25:40] example. That's not a psychiatric issue. That's a known complication of having pain and CBT does work for pain and movement. Symbalta can help with pain. Those are simple interventions, don't necessarily mean that the person has a psychiatric issue.

[00:25:59] guest: So [00:26:00] those would be potentially mid level, uh, psychiatric, or mid level interventions based on the biopsychosocial model, but not based on a biomedical model of psychiatric

[00:26:12] host: change. Some good individual strategies. And then you talked about things that are wrong with the system, right? What systems are [00:26:20] contributing?

[00:26:21] host: to delayed recovery.

[00:26:24] guest: So personally, let's start with the medical. Let's start with me in my office and we've all seen this where, we take over a colleague or we see if you're doing medical legal evaluations or you're doing independent medical evaluations.and you see a [00:26:40] person, you make a set of recommendations.

[00:26:41] guest: This person could do X, Y, and Z and the treating doctor comes back and says, no, they can't. You know, I said that they, X, Y, Z. I think can't do X, Y, Z. that concept of misguided advocate advocate coach in a city where [00:27:00] we say person can't go back to, some task. And possibly they can, or possibly there's a modified work.

[00:27:09] guest: The concept of changing our own, fixed ideas of what a person can do, because sometimes being an advocate for [00:27:20] a patient, we can take it too far.the second issue is medicalizing some of these, uh, psychosocial issues. Um, it's tempting. And the third is excessive workup or excessive treatment. Uh, we've all seen people who've been to, uh, 30 physical therapy, [00:27:40] 50 physical therapy.

[00:27:41] guest: I don't wanna beat upon chiropractors. have had. Uh, 50 sessions of visual therapy or balance therapy or acupuncture. How do we, how do we realize when more is just more?

[00:27:59] host: Yeah, [00:28:00] talk about some of the administrative issues that take away from efficiency.

[00:28:07] guest: All right. So, filling out paperwork, right? So, trying to get that, care pre approved.

[00:28:14] guest: not only doing the paperwork for pre approval, but then once we've put in that [00:28:20] request, knowing if that ever got seen, accepted, worked on, and if the person was referred for treatment. Now, if you look at systems, of best practices, there are timelines for, it's amazing if you look at, official disability guidelines or if you look at Washington State [00:28:40] medical treatment guidelines, it'll say for low back pain first week, second week, fourth week, sixth week, and when was the last time you saw a person four times in their first six weeks after, you know, low back injury.

[00:28:55] guest: the delay is, it's amazing. Accepted at this point. It's an [00:29:00] administrative issue. And really, if we do this right, it can fit into our clinic because now we see people for 10, 15 minutes. We don't have 20, 30 minutes. So fine. I spend 10 minutes with you now. I'm going to see you in two weeks. see you in a week and week.

[00:29:15] guest: We're in two weeks. We're going to do this. And if you haven't, if I see you back in two weeks and you're [00:29:20] on, you're not in physical therapy yet, that's a flag.we need to have efficient denials. We don't have a system, an administrative system for recognizing the at risk worker. Those are all administrative hurdles that I think [00:29:40] insurance companies and employers are interested in looking at.

[00:29:44] guest: We just have, don't have. the system to do it.

[00:29:47] host: A few more minutes left. How can, can, how can technology help? Uh, is AI helpful here?

[00:29:55] guest: So, yes, big data is huge. and, I've been to some of the workers, [00:30:00] the workers comp, national comp meetings, large language, uh, models, big data, AI, um, stratifying risk within medical context is available.

[00:30:12] guest: It is up and coming. early risk stratification, early case management, integrating, another [00:30:20] grabbing systems that can integrate treatment recommendations or best practices or guidelines with pre authorization. Tell, help us as clinicians know when and when not we are meeting The pre authorization guidelines having a big, eh, you haven't done this, you're going to get, you're going to get, uh, denied.

[00:30:39] guest: [00:30:40] Okay, go back, fill, you know, check that box. Those systems can be integrated at a technological basis.

[00:30:47] host: Great, thanks for that. Hey, from your perspective then, What changes or improvements can be made in the worker's compensation system to better address delayed recovery, unnecessary disability, [00:31:00] and high risk payouts?

[00:31:01] host: Wrap it up for us.

[00:31:04] guest: Okay, positive issues. Big data is going to help. Big data. Uh, the insurance companies are motivated, as I said, to improve, to work on that 20%, the 20% of people that cost the most money and, [00:31:20] and resources our time.we as clinicians, uh, need to embrace evidence-based medicine, incorporate treatment guidelines, and there are many, there's the MD guidelines, there's the.

[00:31:32] guest: Uh, California MTOS, there's official disability guidelines, there's state guidelines, uh, there are a number of [00:31:40] guidelines that can be incorporated into best practices. What we as physicians can do is, uh, rely on that evidence based medicine and treatment guidelines and the guidelines are guidelines, they're not rules.

[00:31:52] guest: There's times when we need to advocate for our patients and we need to use to those rules to our [00:32:00] advantage. This person has had an improvement in their function after six physical therapy visits, but six is a recommendation. If someone's improving and has objective interest, objective evidence of improving, then [00:32:20] the guidelines say go to 18.

[00:32:22] guest: We can use those guidelines to advocate for treatment.we need, cost effective interventions that include the biopsychosocial model, and we need a system to help us. We are not going to get this done in the office. And my pipe dream [00:32:40] is that somehow, the worker, these two isolated systems, The workers compensation system and the private insurance system work together, to create a model of wellness that we can [00:33:00] use to, to help our injured workers get back to work.

[00:33:04] host: And I think, uh, we'll leave it on that pipe dream note. I think that's a great place to, uh, keep our Collective thoughts, again, what's, what's good? What's, what's the right thing to do? What's the good thing to do for our patients? And [00:33:20] it turns out for society, right? Uh, corporate goals notwithstanding, uh, usually what's good for a recovered patient is good for the company.

[00:33:30] host: So it shouldn't be mutually exclusive, right?

[00:33:32] guest: Excellent. Yes, I agree.

[00:33:34] host: So, uh, thank you very much. I

[00:33:36] guest: think you summed it up really well.

[00:33:38] host: Absolutely. So, [00:33:40] uh, I want to thank, uh, thank you, Dr. Diana Kramer for joining us for part two of our, uh, discussion on delayed recovery. If you didn't get a chance to check out part one, please do lots of concepts and definitions there, if you're not familiar with some of the concepts that have been discussed today, so we'll leave it there.

[00:33:59] host: [00:34:00] Thanks very much for joining fit for duty. Thanks, Dr. Diana Kramer. And that wraps up another episode of Fit for Duty. Thanks for joining me today, everyone. I hope you found this conversation as engaging and informative as I did. As always, building healthier, happier workplaces starts with knowledge and collaboration.

[00:34:19] host: [00:34:20] So if you enjoyed this episode, please consider subscribing to Fit for Duty wherever you listen to podcasts. That way you'll never miss a beat when it comes to the latest trends, best practices, and inspiring stories in occupational health. Until next time, stay safe. Stay well and keep elevating workplace [00:34:40] excellence.

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