Unfairly Surprised by Your Doctor's Work Release?
I caution all injured workers to look carefully at the physician progress report (PPR) they are handed at the end of each visit to their doctor assigned to treat their industrial injury. Most doctors and clinics that are on the various third-party administrators' medical provider lists use the D-39 form approved by the DIR. Sometimes the clinic or doctor will use a form that looks different, but all PPR's used by Nevada medical providers must show whether the doctor is taking the patient off work completely, or is giving work restrictions until the next scheduled appointment.
If the doctor does not hand you a PPR showing you what your work status is, ask for a copy before you leave the doctor's office. It is important that you get a copy of the PPR so that you know for certain whether the doctor has released you to return to work, and if so, whether you have work restrictions. If the doctor's assistant tells you that you don't need a copy, and that they will fax a copy to your insurer and your employer, nicely explain that you are entitled to your own copy.
Unfortunately, there are a few doctors on the Nevada provider lists that take a cowardly and unprofessional approach to releasing workers' compensation patients back to work. Instead of explaining to the patient that the doctor thinks it's time to return the patient to work, or to any available light duty job, the doctor says nothing when in the examining room with the patient. If the patient doesn't get a copy of the physician's progress report, and the doctor didn't discuss work release status, the patient only learns about what his doctor has done when he doesn't get his next compensation check in the mail.
These doctors shirk their responsibility to their patients because they want to avoid an argument from the patient. The doctor may have good reason for changing the patient's work status, and if so, the doctor should be willing to discuss the reason with the patient. Otherwise, It is extremely unfair and bad medical care not to inform the patient of his changed work status.
If this has happened to you, or you suspect that your doctor may not be up front with you later, be aware that you have an absolute right to change physicians within the first 90 days of your claim. After 90 days you may still request it, but it will be harder if the insurer denies your request and you have to go to hearing. It is also very hard to change doctors after a doctor has just performed surgery on you. Just don't ignore your gut feeling that your doctor is not concerned with your well-being and at least get a free legal consultation to discuss what you can do to protect yourself. Finally, please help other injured workers learn about their rights regarding choice of physicians by sharing this resource and the DIR's website information.
Neck Pain Update on Physical Therapy
I promised to give my honest assessment on whether the McKenzie Method used by the physical therapist I am seeing is helping me. Today, back at work with many people needing to get back on track with their medical care and benefits on their claims after a long holiday weekend, my neck is stiffer than ever. I have only been able to schedule physical therapy appointments once a week with the two holidays, so I should mention that. On most accepted Nevada workers' compensation claims, physical therapy is scheduled for three days a week, and that may make a huge difference. (I do not have a workers' compensation claim. My neck problems are related to age, hours spent in sub-optimal postures in front of a computer, reading late into the night in bed, a few rear-end fender benders over the years, and several significant horse-back riding injuries).
I'm finding that it is frustrating that I am forgetting to do the exercises I have been taught by the therapist at least five times a day. The exercises probably take all of ten minutes to complete, so I don't have a good excuse for not remembering. I think I will simply have to set the alarm on my phone today to make myself do them. Of course, it would be so much easier to take a pill of some sort and have the problem with decreased range of motion, stiffness and pain just disappear. However, I cannot do that. I want to remain clear mentally and crisp with my reaction time for my horse-back riding.
I see that I reported that my range of motion was improved when I actually did the exercises, so I will resolve to make a better effort this week. I did do a lot of horse-back riding the past five days. The type of riding I do is strenuous- jumping and advanced English riding (dressage) on a young Thoroughbred who is emotionally the equivalent of a teenage boy. I also had to survive a New Years Eve party at my house for my son's 22 birthday. This last holiday wasn't exactly relaxing for me. So, here's to trying to take more personal responsibility for my own health in 2012.
Neck and Low Back Pain- Does Physical Therapy Help?
I've had a couple clients referred by local neurosurgeons to a particular physical therapist who is certified in the McKenzie's Protocol, and I decided to investigate this personally. I've got chronic neck pain from various horse-related accidents over the years, and am always searching for ways to increase my range of motion. I also want to decrease the pain and stiffness that extends from neck into the right scapula. Being able to turn my neck better is essential for my riding, as well as my driving.
I know that long hours seated in front of the computer adds to the problem, and the older I get, the more important it is to get up every half hour, stretch and walk around a bit. But stretching on my own, and even the addition of a weekly yoga class hasn't been enough since I re-injured my neck in Ireland during an unlucky fall from a horse. I also added a massage from a highly trained masseuse once a month to keep my back and neck more mobile and comfortable, but that also is not enough.
I made an appointment with the certified McKenzie evaluator and therapist two weeks ago, and I had a second appointment last week. The McKenzie Method (sometimes called the McKenzie Protocol is described in detail in several books written by founder Robin McKenzie back in the early 1980's. Robin McKenzie's is a physiotherapist from New Zealand who developed his own treatment methods for spinal disorders. I purchased two of his books, Treat Your Own Neck, and 7 Steps to a Pain-Free Life: How to Rapidly Relieve Back and Neck Pain. These books, available at Amazon.com, are easy to read. If you need to borrow my copies and promise to return them, call my office and ask my assistant to send me reminders to bring the book to the office for you.
The first book states that it is meant for people with straightforward recurring mechanical problems, and that self-treatment exercises taught by a certified therapist are the key to maintaining neck pain. I do think it is important to invest in at least a couple of sessions with a certified therapist to make sure that the exercises are safe and right for you. The therapist will also want your doctor to prescribe this particular therapy for you (and to get your insurance to cover the sessions if you no longer have an open claim.)
McKenzie emphasizes that there are two types of stresses that can occur to cause neck pain: 1) an accident that results in overstretching of the ligaments and other soft tissue that hold the cervical vertebra together from an outside force, and 2) overstretching caused by postural stresses that place less severe strains on the neck over longer time periods. It is this second type of stress, the one that we exert on our self that can be self-treated for the prevention of neck pain.
Examples of the exercises in the book prescribed for me by the McKenzie therapist include retracting the neck back into the chin, extending the neck backwards, side bending of the neck, and laying on an examining table with the neck extended off the edge of the table. While the book walks the reader through the exercises, and they are very simple, I strongly advise that you first have a certified McKenzie therapist walk you through them.
After the first week of doing neck retraction exercises, I had increased neck pain and even less mobility from placing my neck in very different positions After the second session, the neck pain was improved, and I had a little less pain, but range of motion was still very limited. Then, I miraculously got better about remembering to do the exercises the prescribed 5 times a day. I also became more aware of my posture as I sat at my computer. I also remembered to pick up a new bedside lamp at Home Depot so that I had better light as I continued my bad habit of reading in bed late at night. In other words, I started to take some personal responsibility for making my neck better instead of simply whining about it.
Today, I'm back at work, in front of the computer, but I don't have pain extending into the right shoulder and scapula for the first time in months. The neck pain is lessened, although I still hear a lot of snap,crackle and pop when I go through the range of motion checks. Whether the improvement is due to these particular exercises, my remembering to actually do some stretching and exercises, or a wonderful, relaxing Christmas with my friends and family, I really don't know. But, I intend to give these exercises a good try, and will return to see the therapist tomorrow.
I remain optimistic that this therapy will also keep my clients off the operating table. The number of injured workers who tell me they "want to be fixed" by a surgery concerns me. While I'm not a doctor, I see many people with chronic neck and back pain that might be able to significantly help themselves manage their pain with some guided, concerted effort on their part . Exercises require consistent effort (although these are very easy ones). This isn't a quick fix, but it might be a huge relief once I train myself to do them daily. I will keep you posted. Feel free to post a comment if you have experience with the McKenzie Method exercises.
Nurses and Attendants at Risk for Low Back Injuries
Back injuries, followed closely by shoulder injuries, are the most common job-related injuries for my clients in the nursing field. Nurses, and those employed as nursing attendants are at high risk for these injuries primarily because they must transfer patients from beds to gurneys or to wheel chairs, or to baths.
A new law in California requires hopsitals to establish a "safe patient handling policy", meaning that lifting devices must be used instead of manually lifting patients and that staff must be trained better. The Santa Cruz Sentinel.com reported that studies done by hospitals that had already established those policies in 2004 showed that the rate of injuries among nurses dropped 15%. Handling overweight patients was a particular concern as the population continues to be more obese.
Most hopsitals in Nevada have instituted training on how to transfer and move patients using correct body mechanics. The policy at each hospital may differ on when a nurse is required to use lift equipment. Prevention of these injuries is certainly the key to reducing the number of low back sprains, disc herniations, and back injuries in general that afflict workers in the nursing field. If your hospital does not have good patient lifting policies, you might want to speak to your supervisor or director to see what can be done to obtain new equipment or to get additional training to prevent future injury to yourself and your co-workers.
What if you are a nurse and you do hurt your lower back while transferring a patient? Follow all of the ordinary steps for filing a claim and getting medical care as directed by your employer. You should notifiy your nursing director or supervisor immediately in writing if you think you may have hurt your back, even if you don't think you need to see a doctor right away. Many times a person may not know how serious the back injury is, thinking that they have a muscle strain that will feel better in a day or two. Report the injury anyway on a Notice of Injury form. The law requires injured workers to report injuries in writing within 7 days of the accident.
The law also requires that an injured worker obtain medical care within 90 days of the accident and complete the C-4 Claim for Compensation if the worker ever intends to pursue a claim. After you notify your employer of the incident causing you back pain, make sure that you go to the clinic where your employer directs you for a work-related injury once you realize that you need medical attention. Be clear on that form about the date you injured your back and how you injured it. Be as specific as possible about how the accident occurred. If you only think you might have injured it work, but aren't sure about how and when you injured it, the claim will be denied. Remember, there is no claim until you complete the C-4 form at a doctor's office.
Once the claim is accepted, if your back injury is not getting better following some physical therapy and anti-inflammatories, I recommend that you request a transfer of care from the intitial clinic to either a physiatrist or a spine specialist on your insurer's provider list. You are entitled to ask your adjuster for a copy of the insurer's provider list so that you may select a physiatrist, or an orthopedic physician, or a neurrosurgeon. Most back injuries will heal in time, but if yours requires surgery or is so debilitating that you may not be able to return to your profession in the nursing field, you may want to consider a consultation with an attorney to make sure you know your rights. A book that provides a good discussion of treatment options for low back injuries is Your Aching Back, by August A. White III, published by Simon and Shuster, and available at www. amazon.com.
Depression and Work Injuries in Nevada
If you have a work injury in Nevada you are more likely to become depressed. If you do need a study to prove that there is a higher incidence of depression among workers with orthopedic injuries, you will be interested in the linked article from California psychologist Stephen Pfeiffer, Ph.D., He cites a study reported in the Annals of General Psychiatry, Dr. Pfeiffer frequently writes about depression and other psychological conditions affecting California's injured workers.
Unlike Dr. Pfeiffer, I am not a doctor. I am a lawyer who represents injured workers. The following are my Top Ten non-medical reasons injured workers tell me why they feel depressed after their job accident:
- They're hurt and in pain. That alone makes them unhappy.
- A supervisor, or co-worker, or their adjuster acts as if they are faking their injury...
- They are worried about whether they will still have a job when they are well again..
- They are getting the run-around from whomever is supposed to be handling their claim.
- They know they aren't getting good medical care, but don't know what to do.
- Authorizations for medical care take forever.
- They are worried about how they will make a living if they can't go back to their line of work.
- They're financially behind on bills as a result of late compensation checks, no compensation checks, or inadequate compensation checks.
- They hear stories that they might get a settlement at the end of their claim, but have no idea what to expect, or whether to hope for anything.
- They are worried about needing medical care in the future if the injury ever worsens after the claim is close.
- They know they need information, but don't know who to trust for advice.
Depression is serious. If you are feeling completely overwhelmed or suicidal, please tell your doctor immediately, or call 911 and ask for the suicide prevention hotline. While it can be difficult to obtain psychological treatment for depression on a worker's compensation claim, it can be done under the right circumstances. More importantly, many feelings of helplessness go away once you are armed with knowledge about how the claims process actually works. If you feel too lousy to actually meet with a lawyer for a free consultation, at least help call for a free guide so that you have a better understanding of Nevada workers' compensation law.
