Letters to the Editor
Pain sucks for injured workers
Continued from P2
Dear Editor ,
Mr Chris White , CEO , WorkCover WA ( WA compo compares favourably , June 2013 ) rightly calls for factual information to support any suggestions as to how the scheme he administers could be improved . In so doing , he has sidestepped the call for reform of the system made by pain specialists Drs John Salmon and Stephanie Davies ( Management of WA ’ s work injured needs reform , May 2013 ).
Does WorkCover have a case to answer or are these experienced pain specialists making a big fuss about nothing ? Well , let ’ s look at some facts .
In the WorkCover WA Guides for the Evaluation of Permanent Impairment ( 3rd edition , 2010 ), we read that because there is currently no validated measurement tool for the assessment of pain , WA has followed the NSW WorkCover Guides by excluding Chapter 18 ( The Assessment of Pain ) of the AMA ( US ) Guides V . Without providing any factual evidence to bolster its position , WorkCover WA claims that pain has already been factored into the impairment ratings for demonstrable work-related conditions .
If that were indeed the case , extrapolating from this administrative decision , one might reasonably expect to find that the Guides being used in WA ( and NSW ) rely upon the use of validated measuring tools to determine the extent of bodily impairment .
But that is not the case : there are hardly any studies that would validate the assessment of
Star
Joke
A very old , wizened man in robes went to his GP and sat wearily at his desk .
“ What seems to be the problem ?" asks the GP .
" Well doctor , I hope that you can help me ," the old man replies . " I am a man of religion , and I spend my days walking everywhere and preaching the word . My faith prevents me from wearing footwear of any kind and now my feet look like this ."
The man puts his feet on the desk . The GP winces , noting both feet are covered in very hard calluses .
" I see ," says the GP . " Is there anything else ?"
" Well ," the man responds , " my faith will only allow me to eat curded yam , and I fear I am growing weak .." He pulls up his robe and the physical impairment currently being used by WorkCover . [ Davies , 2008 ]
This is doubly detrimental to the injured worker with ongoing pain and apparently little or no assessable impairment . Contrast this to the attempt to resolve the vexed question of psychiatric impairment .
Here , not only does WorkCover WA use ‘ impairment ’ as a surrogate term for ‘ disability ,” but also Approved Medical Specialists ( AMS ) are mandated to use the Psychiatric Impairment Rating Scale ( PIRS ), which was constructed by an expert group of NSW psychiatrists .
The PIRS comprises six subscales , each of which is said to delineate and evaluate discrete areas of functional impairment : self-care and personal hygiene ; social and recreational activities ; travel ; social functioning ( relationships ); concentration ; and employability .
Data on the reliability and validity of the PIRS has yet to be published by NSW WorkCover , although it did fund such a study in 2003 . [ Davies , 2008 ] Could it be that the results were inconclusive ( or even worse than that )? Furthermore , the final calculation of impairment rating using the PIRS is skewed towards the lower scores , thus reducing the overall amount of compensation paid . [ Davies , 2008 ]
But at least workers with psychiatric impairment / disability are afforded a mechanism of sorts for assessing their entitlements . Why are workers with chronic and disabling pain being denied the same opportunity ?
Given that each of the original PIRS subscales applies equally to the assessment of painrelated impairment / disability , WorkCover
GP winces again . The man has the body of a thyrotoxic greyhound .
" I see ," the GP replies once more . " Is there anything else ?"
" Well , the curded yam has another unwanted side effect ." And with that he breathes out in the stunned GP ' s face . The GP winces again , and almost passes out from the foul odour .
" So tell me doctor ," asks the old man , " what do you think is wrong with me ?"
The GP collects himself and says , " I am afraid you have Mary Poppins Syndrome ."
" Mary Poppins Syndrome ?" exclaims the old man . " What is that !"
“ It means ," the GP replies , " you ' re a supercallused fragile mystic plagued by halitosis " could easily formulate a Pain Impairment Rating Scale . This would rectify the glaring anomaly and ensure both equity and consistency in AMS assessment .
As an additional benefit , it would remove the stigma of chronic pain that appears to have become part of the workers ’ compensation culture in WA . This benefit would spin off into the world of third party insurance where , according to Drs Salmon and Davies , insurers currently seem to be following WorkCover ’ s lead and are denying injured workers early access to evidence-based assessment and pain management that , ironically , would likely improve return to work outcomes .
Mr White refers to the balancing act to ensure that the requirements and interests of participants in the scheme are being met . The recommendations made by Drs Salmon and Davies should be seen in this light and not swept under the carpet , yet again .
Dr John Quintner . Consultant Physician in Rheumatology and Pain Medicine
Davies GR . The psychiatric impairment rating scale : is it a valid measure ? Australian Psychologist 2008 ; 43 :
205-212 .
Equitable share of resources a right
Dear Editor ,
In response to “ Give a Little Bit …” ( June edition ), my involvement in founding a Not-for-Profit has raised myriad questions for me about “ aid ”, giving , donors and basic human rights . Researching this process , I was impressed by the number of fantastic Australians who have initiated development programs around the globe . They shared their advice and expertise freely .
The work that we now support in India started 40 years ago . Training health workers , focusing on mothers and providing education support has resulted in massive , sustainable and intergenerational change .
Working in remote Australia I see the devastating effects of intermittent funding , endless “ new ideas ”, short-term commitments driven by political interests and a lack of cultural and historical understanding . When short-term funding ends and eager plans evaporate , the questions focus too readily on the community rather than unrealistic planning . Sustainable change takes time and requires reliable funding and local knowledge .
Australians have a generous spirit but there is still more to do . Parents and teachers can model the value of sharing , businesses can support employee donations , large corporations can share their profits and governments can ease restrictive tax deductibility policies .
Continued on P6
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