2/17/2015

Strategies for a Better Return-to-Work Process

How to provide not only empathy for injured workers and their families, but also the assurance of proper care.

By Mark Pew

My dad passed away on Nov. 9, 2014, from complications of Parkinson’s disease. If you know anything about Parkinson’s, you know that it involves years of gradually declining health ending in months of doctor, hospital, and rehabilitation visits. I remember my father-in-law passing away 20 years ago, but this was closer and more intense since I am an only child supporting both Dad and Mom.

In my workers’ compensation career, I have long advocated for the appropriate care of injured workers, particularly appropriate drug regimens. When injured employees regain function and their quality of life and ultimately return to work, the most important stakeholders in the system—the employee and employer—win.

However, when inundated by inappropriate treatments, egregious costs, and improper motivations, it’s easy to lose sight of the person and the family behind the claim. An injured worker can become just a claim number or the “other party.”

My father’s passing was a poignant reminder for me that we need to remember that injured workers are people. They are members of families that have encountered life-altering events and now face uncertain futures. A balanced view of the financial implications with an understanding of the injured worker’s personal needs and concerns is difficult. The health crisis I have just navigated through created a new empathy and an understanding of what others are feeling because I’ve personally experienced it. It reinforced three lessons that can apply to the management of claims and help us all refocus as we start a new year.

Talking about things is much easier than doing them. I have studied drug therapy for chronic pain since 2003, collaborated with people smarter than I am, created services to help address the issue, written articles, and educated more than 12,000 people since February 2012. I’ve talked about how opioids are primarily meant for use before, during, and immediately after surgery, cancer, AIDS, and end of life. Countless workers’ compensation professionals have relayed personal stories to me after my presentations. For example, the brother-in-law who is abusing prescription drugs and, because his wife is enabling him, his children are not allowed to visit extended family. Another person’s brother died from an accidental overdose, and another has a friend who is on the “Las Vegas Cocktail” (a combination of hydrocodone/acetaminophen and carisoprodol).

It’s easy to take an anti-opioids and anti-drugs position. But it’s entirely different to deal personally in hospice with the need for morphine to ease obvious suffering and lorazepam for anxiety. Now I have my own more personal story about the proper and positive use of these powerful painkillers.

Lesson: Understanding the limited appropriate uses of opioids helps to define when they are being misused and should strengthen our desire to find less dangerous treatment options.

Complicated drug regimens can be very confusing. Mom and I could not understand why Dad’s drug regimen changed when he moved among different doctors and facilities. We couldn’t always keep track of all the drugs (oral and intravenous) being provided and their effects on his treatment and health (prompting many visits to drugs.com). When Mom was his sole caregiver, she was personally responsible for massive numbers of different pills at different times for different reasons. If something wasn’t administered properly, it might have had serious ramifications. This responsibility came while Mom was emotionally overwhelmed by this disease ravaging her soulmate of 57 years and I was managing a cross-country travel schedule that forced most of my interactions to be conducted via telephone. There was so much to consider, and in most cases, they were life-and-death decisions that needed to be made quickly.

Lesson: Recognize how confusing and frightening the process is for injured workers and their families, encourage questions, and help them to evaluate and simplify options.

Bedside manner matters. I will always remember the emergency room doctor who had just come on duty and didn’t really know the history of our case or what was happening, giving us random answers that did not compare to what we had been told previously. I will remember the first discussion with the hospitalist who indicated that Dad’s aspirated pneumonia was the start of a deadly cycle to be repeated and the compassion in her eyes (and the blank looks on the faces of her team of residents). I will remember the neurologist who had treated Dad for several years choking back tears when telling us that things didn’t look good. I will remember the hospice staff that was forthright but caring, somehow managing to stay emotionally detached and yet provide tremendous comfort.

When you’re trying to figure things out in an emotional fog, you need honest answers shared in human terms. And as self-reliant and strong as you think you are, you’re still not prepared.

Lesson: Empathetic yet objective communication makes a difference.

A simple phone call to seek to understand first helps create a relationship. A projection of caring from the employer and claims administrator can break down barriers of the us-versus-them mentality. As C. S. Lewis wrote, “The proper aim of giving is to put the recipient in a state where he no longer needs our gift.” Maybe our “gift” needs to be a renewed human touch.  



Mark Pew is senior vice president for PRIUM. He has been a CLM Fellow since 2011 and can be reached at mpew@prium.net, www.prium.net.

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