and even amputation, at a similar cost. Confront these risks proactively by remaining on the lookout for early signs of these complications. Then, act to prevent and/or mitigate the problem and expense. Mr. G did indeed have an injury to the nerves in his left arm and pain limiting his use of the arm. He also had a cyst in his spinal cord that could be contributing to pain and threatened his future arm function. Treatment interventions, including surgery, were considered and pursued. 4. PREDICT LONG-TERM OUTCOMES AND DETERMINE THE MOST DIRECT TREATMENT STRATEGY TO THOSE RESULTS. This is the big picture approach. It is also a way to get a more accurate understanding of the long-term costs. Ask: • Where will this case end up? • What are realistic expectations? • How do we help the injured worker get there efficiently? • What will it cost? Most treating physicians are not trained to predict long-term treatment outcomes or
complications. Traditional medicine is more of a “see how it goes” endeavor. Studies repeatedly reveal the challenge in getting many treating physicians to use objective tools. Among other reasons, physicians say they believe their experience is sufficient. It’s important to identify a clinician who can synthesize the medical information and the severity scales, then make functional and medical outcome predictions using that information to develop the care plan. Ideally this specialist is well versed in the clinical topic and insurance concerns. A plan was made for how Mr. G would function whether his arm recovered and if it did not. Specialized testing was arranged in an effort to prognosticate the nerve injury. A monitoring plan was set for his arm function. Likely outcomes of the spinal cord injuries were established as part of discharge planning. 5. UNDERSTAND EARLY THAT THESE CONDITIONS ARE BIOPSYCHOSOCIAL— NOT JUST MEDICAL. Even the most stoic person can struggle to accept and recover from an injury and a disability. This is where compassion and empathy become important in the case predic-
tion and management approach. Emotion, health literacy, family issues, depression, anxiety, avocational activities and more affect how people report symptoms, cope with recovery, comply with treatment and accept residual disability. These factors can dramatically affect speed and extend of functional recovery. Being creative and mindful of the individual’s personal needs, culture and coping style will help you to incorporate the right resources and providers. A psychosocial assessment in your case conceptualization allows you to monitor psychosocial issues and intervene appropriately. It is critical to be aware of and to address any condition that may delay or limit medical and functional outcomes. Mr. G focused on his physical discomforts initially, managing nausea and severe pain. It is expected that as the nature of his disability becomes apparent, he will need help coping. Though his ASIA B classification provides hope, there is the risk of false hope of recovery as well. 6. HAVE A PROCESS TO NAVIGATE AND STEER A CASE WHEN IT GOES OFF TRACK. Even the best plan may need to change when
Equally important are psychosocial factors that often do not become known until later in the recovery process. Having a clinician with expertise in these diagnoses review the records and discuss the findings with the treating physician is invaluable. A proper assessment ensures you are aware of the factors that will promote an optimal recovery short- and long-term.
MARCH 2019 | PUBLIC RISK
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