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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