Case Scenario I have a patient wh...

Case Scenario

I have a patient who had major abdominal surgery a not many years ago for a fulminant illness. Not prolonged ago, on his first visit to my office, he handed me a disability form. He said that he had chronic pain and that I penuryed to get this form filled revealed quickly because he had no currency to live on. My close examiner and I smelled alcohol onward the patient's breath.

I could not determine from the operative report or other records whether alcohol played a part in his illness nor do the records indicate with what intent he might still be in pain. Pain could be a issue of the surgery, but I did not think that it was up to me to decide whether his pain was debilitating. The fact that he had been drinking certainly diminished his credibility with me equal though he insisted that he drank solitary rarely.

I explained to him that as a physician, I could solely report on his medical condition. I filled without the disability form as well as I could summarizing his surgery stating that the patient complained of ongoing pain, and indicating that I was unable to determine whether this was a condition that could flow in permanent disability.

At his nearest visit, the patient presented me with another blank disability form. He also showed me a note from the agency, which stated that the claim was not denied, if it be not that that more evidence was extremityed to prove he was disabled. He gave me the blank form to complete

Having already provided the facts to the best of my ability, what additional information was being requested? Was I being reckon uponed to steer the interpretation of the medical condition in a particular direction? As it happened, following labwork showed abnormalities that allowed me to propose a diagnosis, even if it was an unlikely cause of the actual pain.

I have been told that physicians should just state the facts about our patients, and that someone otherwise will make the disability decisions. Is that correct?

Commentary

In answer to a patient's expression of pain, the physician should remember that symptoms must be related to specific findings. Social Security specifically defines an impairment as single that is objective by more [i]or[/i] less measure and "not only according to the individual's statement of symptoms." If the patient has no hernia, no adhesions, and no hurt or bowel complications, and objectively has no reasonable, diagnosable cause for pain, there is really no objective basis for finding a functional limitation, and this fact should be made known to the adjudicator.

If, in succession the other hand, there are objective abnormalities or diagnoses that could reasonably cause the alleged pain, the physician should state what those objective findings are and to what extent limiting they are to functional capacity (eg lifting, standing, walking) in this patient.

It is not clear which agency--a workers' compensation combination of parts to form a whole or Social Security--is requesting more evidence in succession the patient's disability claim. If the evidence is for a Social Security disability claim, the physician can always call the state office of Disability Determination Services for Social Security (DDS) and ask for clarification. Each of the 50 states has similar an office.

For Social Security disability claims, it is not asked of the physician to provide a disability determination. In fact, the determination of disability is legally reserv barely to the Office of the Commissioner of the Social Security Administration or its agents. However, Social Security and many other disability programs frequently request a physician to provide detailed information forward the extent of physical impairment exhibited in a patient. In other words, they want to know specific, objective physical findings that would limit the performance of basic work activities like as standing, walking, lifting, carrying, seeing, hearing, etc

forward the form from the disability determination agency (or in a separate note), the physician can document diagnoses and the objective findings he has observ and he also may give an opinion regarding the event of these impairments on functioning. For example, he might state: "Mr Jone has a 3 3 4 cm reducible, moderately feeble incisional hernia superior to the umbilicus. This hernia becomes large and painful with any exertion above about 20 lb of lifting, based upon my observations and his report. He can walk and stand without limitation, nevertheless he should avoid lifting percepts over 20 lb in weight reject on rare occasions."

like a statement will tell the adjudicators of the disability claim the amplitude of the impairment (the hernia) and the order of limitation it exerts onward his life activities, including work. The clinician should avoid using confines such as "disabled" or "totally disabled." These are not determinations for physicians to make.

Physicians can document impairment and the severity of impairment-related limitations, on the other hand unless they are employed according to a disability determination service, they should not make administrative disability determinations.

Physicians can avoid wearing the "black hat" of disability determination and own their patients that they will be glad to document the details of the diagnosis and the impact of that diagnosis upon functional capacity, but that the determination of disability is not part of a physician's part and, with regard to Social Security disability, is not within his authority.