Medical History

  • RateFast and Goliath

    30 August 2013 / California Workers Compensation, Medical History, RateFast / Comments Off on RateFast and Goliath

    Everyone recognizes Michelangelo's statue of David, which today stands proud, tall, and butt naked in the Signoria Accademia Gallery. However, not everyone knows that the carving of Michelangelo's David began before Michelangelo was even born.

    1464, Carrara, Italy. The marble quarry is jagged with the cut away chunks of stone. Miners cart a seventeen foot tall chunk of mountain toward Florence. Within this stone, beneath layer after layer, chip after chip, stands a symbol of fierce pride, culture, and strength.

    Photo credit: Hans Thijs

    The artist Agostino was contracted to make the statue of David, but he abandoned the project for unknown reasons. A decade passed, and Antonio Rossellino was brought in to finish Agostino's work. But Rosselino's involvement was also short lived, and the block of marble was left out in the yard of the Florence Cathedral's workshop, where it weathered the elements for 25 years.

    In 1501, nearly half a century after the project began, 26 year old Michelangelo di Lodovico Buonarroti Simoni outcompeted Leonardo da Vinci and other more experienced artists for the contract to finish the statue of David. After two years of attending to the stone, Michelangelo succeeded in crafting one of the Western culture's most significant works of art.

    Michelangelo's piece shows David prior to fighting Goliath, unlike Donatello's and Verrocchio's statues of David, which show the biblical figure holding the monster's decapitated head, already victorious. Scholars interpret Michelangelo's David as a snapshot of the moment after David has made the decision to fight Goliath, but before actually defeating him.

    The statue, whose stoic face points towards Rome, announces the change coming to a land, a culture, a time. In the world of California Workers' Compensation, RateFast points toward a new future—a future where the efficiency and accuracy of medical legal reports is prioritized, and where doctors, insurance adjusters, and injured workers can rest easily, knowing that their impairment rating is accurate, and incontestable.

    David's confident expression and relaxed posture symbolize RateFast's approach to the Goliath of today's worker's compensation system. You don't need armor and swords to tackle the rules of the A.M.A. guides—a well placed impairment rating, shot from the sling of RateFast, is all that it takes to bring that giant down, and allows everyone to go home early.

    For more information on Michelangelo, visit Artsy.net's wonderfully helpful page on the artist's life and works.

  • NFL image.

    NFL Athletes vs. California

    30 July 2013 / California Workers Compensation, Medical History / Comments Off on NFL Athletes vs. California

    NFL player retires. NFL player suffers from cumulatie trauma—injuries that are incurred gradually over the course of a career spent crunching skulls on the gridiron. NFL player doesn’t want to pay for his injuries out of pocket, but the player has a hard time getting the NFL to pay for his coverage—except in the state of California.

    For a long time, California’s relatively liberal workers’ compensation system has allowed non-Californian professional athletes to get medical coverage, provided that the athletes played games in California at some point during their career. The NFL and other sports leagues don’t like this, because it means that they get stuck with the six-figure cost of treating their players’ injuries, which often last a lifetime.

    Enter Bill AB 1309, which, if approved by the Senate, will prevent prevent out-of-state athletes from using California as a way to get the NFL (or other sports leagues) to pay for their  medical expenses.

    The bill plugs up a leak for professional sports leagues and other businesses to whom California’s workers’ compensation system has been something of an achilles heel.

    Assemblyman Henry T. Perea (D-Fresno), who wrote the bill, said that California’s workers’ compensation system “has been increasingly exploited by out-of-state professional players at the expense of California teams and all California businesses... The flood of claims are raising insurance costs for all employers."

    However, on the other side of the fence, retired athletes and workers’ rights groups oppose the bill. Some maintain that taking away NFL players’ ability to get compensated for injuries partially sustained while in California sets a “dangerous precedent” for denying other workers’ coverage.

    Sarita Gupta, executive director of Jobs with Justice (JwJ), argues that NFL players are entitled to use California’s system provided that they have played a reasonable amount of games and paid taxes in the state.

    According to attorney Dawn Neufield, another AB 1309 antagonist, California’s economy stands to gain from allowing professional athletes to use its workers’ compensation system: “California collected roughly $171 million dollars in taxes from professional athletes last year. So California's economy benefits from these players' taxes, and yet state legislators are still trying to deny them benefits.”

    Here at PR4reports.com and RateFast, our mission is to get fast and accurate impairment ratings for injured workers, not to determine who gets an impairment rating in California and who doesn’t. However, the controversy of AB 1309 raises larger questions about the system that we are attempting to help medical professionals navigate more efficiently. Which California workers qualify as California workers? Where does the line get drawn?

    As of last week, the bill is being fast-tracked. In an attempt to mollify injured athletes who have already applied for workers’ compensation in California, some 6,000 claims that have already been filed will still be processed within the current system. We should be curious about whether or not this batch of claims are the last of their kind in the state.

  • Elementary, my dear Watson!

    25 July 2013 / California Workers Compensation, Chart Reviews, Cloud Based Computing, Impairment Physical Exam, Impairment Rating Specialists, Medical History, Medical Technology / Comments Off on Elementary, my dear Watson!

    There’s a new cloud-based computer service that takes in patient information and then spits out useful results in record time. And no, I’m actually not talking about RateFast. Did you catch the 2011 Jeopardy special where Watson (IBM’s language savvy super-computer) competed against two former Jeopardy champions? The AI system out-answered—or rather, out-asked—both of its human opponents, and won $1 million in prize cash.

    But Watson’s verbal talent is now taking on questions that are tougher than those Alex Trebek would ask: the computer system is diagnosing and generating treatment plans for cancer patients. An agreement between IBM, healthcare company Wellpoint, and Memorial Sloan-Kettering Cancer Center is going to make Watson’s thinking power available to hospitals and clinics around the nation.

    Here’s how it works: you’re a doctor, and you need to write a treatment plan for your patient, but you’re stretched for time, knowledge, resources—or maybe you just want a second opinion. So you log into Watson using an app on your tablet or computer, and you enter your patient’s medical situation. Within minutes—usually within seconds—Watson gives you a series of treatment plans based on the latest medical research, and each plan is ranked by its expected effectiveness and cost.

    Over the past few years, Watson has become an expert oncologist. According to an article at Wired Magazine, Watson needs only a few seconds to search through “600,000 pieces of medical evidence, more than two million pages from medical journals” and 1.5 million patient records. Wellpoint clams that Watson can correctly diagnose lung cancer 90% of the time, as opposed to the relatively paltry 50% correct-diagnosis rate of a human doctor.

    For now, Watson’s expertise is restricted to lung, prostate, and breast cancer, but the computer never stops learning. It’s difficult for doctors to stay abreast of the current medical research in their field, but Watson can “read” the results of new studies as they’re published, and instantly apply the information.

    The Memorial Sloan-Kettering Cancer Center in New York says that it would take 160 hours of reading a week for a doctor to stay current on all new medical knowledge as its published—and that doesn’t even account for applying that knowledge (or taking care of tedious clerical work like filling out PR-4 reports). Obviously, no human medical worker can do what it takes to know everything about their work. But Watson and computer systems like it are unencumbered by the human weakness of, you know, having a life.

    The goal is to have computers crunch numbers and negotiate the rules of today’s labyrinthine healthcare system, while medical professionals can leave work on time. Watson could be a major wave in medical technology’s recent move toward cloud-based apps that aim to streamline productivity around hospitals and clinics.

  • It Hurts Too Much for Me to Work

    07 February 2013 / California Workers Compensation, How To, Impairment Physical Exam, Medical History / Comments Off on It Hurts Too Much for Me to Work

    “It hurts too much for me to work” is a common complaint in the clinic.

    In this situation be sure you have clearly reviewed the physical exam findings, objective imaging (x-ray, MRI, consultant opinions, etc.). Inform the patient that the pain is not dangerous, but does require activity modification during the healing process.

    Movement is essential for soft tissue recovery, as is strengthening and following conservative treatment measures. If the worker is still having difficulty tolerating work one of two things can be additionally done.

    The first is to shorten the work day.

    I reserve this for situations where there has been a reasonable change in condition, and the subjective findings are at least in part supported by objective findings i.e. increased muscle tension, guarding with distraction on exam, and good compliance with therapy attendance etc. I will often shorten the shift by a maximum of 1-3 hours.

    “Still hurts too much”.

    At this point I will revisit my work restrictions and see if they can be further limited with regards to weight bearing, bending, and lifting. In general I do not place anyone on a work shift less than 4 hours, and preclude lifting less than 10 pounds, or bending less than 10 x per hour.

    The reality is that these are the basic minimal required functions for activity of daily living i.e. dressing, shopping, preparing food and self hygiene etc. I also point this out to the patient.

  • A Witnessed Injury and Taking the Medical Impairment History

    15 October 2012 / How To, Medical History / Comments Off on A Witnessed Injury and Taking the Medical Impairment History

    Was this a witnessed injury?

    • Who was at the injury?
    • What was their name and job title?
    • What was the interaction with this person?
    • Did this person help them initially at the injury?
  • Who Was Hurt and The Medical Impairment History

    08 October 2012 / How To, Medical History / Comments Off on Who Was Hurt and The Medical Impairment History

    Questions to ask when taking the medical impairment history:

    Who was hurt?

    • Was this person with or without pain at the time of the reported injury?
    • What was their baseline pain and medication usage?
    • Did their baseline pain change?
    • Did medication need change as a result of the injury?
  • Injuries and The Medical Impairment History

    02 October 2012 / Medical History / Comments Off on Injuries and The Medical Impairment History

    When was the injury?

    Date, time, location and circumstances. Auto accidents include visibility and driving conditions. Any amount for damages, monetary settlement?

    Consider lighting and also were they in an unfamiliar environment i.e. working off site or at a client’s location?

  • How to Take the Medical Impairment History

    24 September 2012 / Medical History / Comments Off on How to Take the Medical Impairment History

    Let the first sentence put a picture in the mind of the reader: name, age, handedness, employer and number of days, months or years with the employer.

    Let the worker tell you what they do, remember, details make your history memorable and fun to read. Listen to the first task they list and try to get a sense of the working conditions, the hours and tools they use.

    • Include both the physical and administrative functions of the workers.
    • What do they offer as their first and primary function on the job? What tools or objects do they use during the shift? Who do they report to, who do they supervise?
    • Work attendance history and disciplines/promotions.
    • How much work has the employee missed, not just for this injury, but also in the past? Have they been promoted? Demoted or placed on a performance improvement program at any time?
  • Taking the Medical Impairment History Interview

    04 September 2012 / Medical History / Comments Off on Taking the Medical Impairment History Interview

    Lay the ground rules for the exam before you start the interview:

    1. The answers are to only be provided by the employee.

    2. The interviewer is not a treating provider and there is no doctor patient relationship. Make sure the patient understands this before you begin, otherwise they will continue to ask you questions as a primary treator.

    3. Information shared in the interview will be included in the report and communicated with all parties. If the employee chooses not to answer a question they need to state so, and the interviewer will move on to the next question.

    4. At any time in the interview or exam, if the employee experiences pain they are to stop any painful activity immediately and notify the examiner.

  • Taking the Medical Impairment History from the Employee

    31 July 2012 / Medical History / Comments Off on Taking the Medical Impairment History from the Employee

    Let the first sentence put a picture in the mind of the reader: name, age, handedness, employer and number of days, months or years with the employer.

    Let the worker tell you what they do, remember, details make your history memorable and fun to read. Listen to the first task they list and try to get a sense of the working conditions, the hours and tools they use.

    • Include both the physical and administrative functions of the workers.
    • What do they offer as their first and primary function on the job? What tools or objects do they use during the shift? Who do they report to, who do they supervise?
    • Work attendance history and disciplines/promotions
    • How much work has the employee missed, not just for this injury, but also in the past? Have they been promoted? Demoted or placed on a performance improvement program at any time?
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