Orthopaedic Surgery Orthopaedic Surgery IMEIME & Workers’ & Workers’ CompensationCompensation

Richard J. Friedman, MDRichard J. Friedman, MDCharleston Orthopaedic Charleston Orthopaedic

AssociatesAssociates

DisabilityDisability Alteration of an Alteration of an

individual’s ability to meet individual’s ability to meet occupational, personal or occupational, personal or social demands because of social demands because of an impairment. an impairment.

ImpairmentImpairment A deviation from normal in A deviation from normal in

a body part or organ a body part or organ system and its functioning.system and its functioning.

WC EvaluationWC Evaluation Performed to assist in the Performed to assist in the

evaluation of work-related evaluation of work-related injuriesinjuries

Evaluation of permanent Evaluation of permanent physical impairment is the sole physical impairment is the sole responsibility of the physicianresponsibility of the physician

Need cooperation and input of Need cooperation and input of nurses and case managersnurses and case managers

WC EvaluationWC Evaluation Orthopaedic surgeons very Orthopaedic surgeons very

involvedinvolved No trainingNo training Conflict of interestConflict of interest Secondary gainSecondary gain Poor system with little Poor system with little

incentive for the patient to get incentive for the patient to get betterbetter

WCWC Physician must act without Physician must act without

bias or preconceived viewsbias or preconceived views Must treat patient with Must treat patient with

respect, dignity and in a respect, dignity and in a friendly manner.friendly manner.

Change in Change in Physician’s RolePhysician’s Role

PATIENTPATIENT

HISTORY PX EXAM HISTORY PX EXAM TESTSTESTS

PHYSICIANPHYSICIAN

Change in Change in Physician’s RolePhysician’s Role

PATIENTPATIENT

LAWYER PHYSICIAN EMPLOYERLAWYER PHYSICIAN EMPLOYER

ADMINISTRATOR/ADJUDICATORADMINISTRATOR/ADJUDICATOR

DISABILITY RATINGDISABILITY RATING

SimilaritiesSimilarities Gather patient’s historyGather patient’s history Perform physical examinationPerform physical examination Order appropriate lab testsOrder appropriate lab tests Assimilate the informationAssimilate the information Report the information Report the information

obtainedobtained Act ethicallyAct ethically

DifferencesDifferences GoalsGoals Treatment Treatment

recommendations recommendations Work historyWork history Rating system requirementsRating system requirements End resultsEnd results

DifferencesDifferences Peripheral issuesPeripheral issues Reliance on non-medical Reliance on non-medical

personnelpersonnel Specific issues addressedSpecific issues addressed CausationCausation Legal responsibilitiesLegal responsibilities Referral sourcesReferral sources

Understanding the Understanding the Needs of the Referral Needs of the Referral

SourceSource What critical questions must What critical questions must the medical consultant ask the medical consultant ask of the referral source?of the referral source?

What are the issues of this case?What are the issues of this case? What is the purpose of the What is the purpose of the evaluation?evaluation?

What are you asking me to do?What are you asking me to do? What questions do you want me What questions do you want me to answer?to answer?

Contents of the Contents of the ReportReport

Results of the clinical Results of the clinical evaluationevaluation

History of the medical conditionHistory of the medical condition Findings of physical examinationFindings of physical examination Findings from laboratory tests Findings from laboratory tests and diagnostic procedures - x-and diagnostic procedures - x-rays, MRIrays, MRI

Clinical impressionClinical impression

Contents of the Contents of the ReportReport

Medical management planMedical management plan Recommendations for further Recommendations for further diagnostic testsdiagnostic tests

Active treatment planActive treatment plan RehabilitationRehabilitation Follow-up evaluationFollow-up evaluation Return to workReturn to work

Shoulder InjuriesShoulder Injuries Muscle strainMuscle strain TendinitisTendinitis AC separationAC separation DislocationDislocation SubluxationSubluxation Impingement / rotator cuffImpingement / rotator cuff SLAP tearSLAP tear FractureFracture

Knee InjuriesKnee Injuries Ligament sprainLigament sprain Muscle strainMuscle strain TendinitisTendinitis Torn meniscusTorn meniscus Osteochondral injuryOsteochondral injury FractureFracture DislocationDislocation

Questions?Questions?Confusion?Confusion?

Thank You.Thank You.