I just returned from a trip to England, Ireland, Scotland and Wales studying their new national work disability prevention program, the Fit for Work Service and the events that led up to its creation. It was a professional dream trip, and there are stories to tell. But the MAIN THING I want to tell you today is a realization that dawned as I was on the plane back home. I suddenly noticed that virtually all of the people I had met who have been persistently, solidly, visibly, and credibly leading or supporting the change efforts in the UK and Ireland are CLINICIANS, and nearly all of them are PHYSICIANS. I met with Sir Mansel Aylward, Dr. Debbie Cohen, Dr. Kim Burton, Dame Carol Black, Dr. Bill Gunnyeon, Dr. Rob Hampton, Dr. Ewan MacDonald, and Dr. Clem Leech. It was quite a shock once I noticed it, because I realized that there are few or no physicians playing equivalent roles in the US. I wonder why not, and whether this should change.
I’m not talking about the political leaders. I’m talking about the subject matter experts who analyzed the problems (made a diagnosis) and came up with the ideas for what could improve it (treatment plan), and then patiently championed the cause, speaking on behalf of specific ideas for what needed to be done in order to provide more effective HELP to people to reduce the impact of injury, illness, age and congenital conditions on their lives – and then designed the initiatives and run the pilot programs, etc.
I have spent more than 30 years in the private sector, and only in the last couple of years have entered the Federal disability “marketplace of ideas”. I’ve been rather steadily introducing the work disability prevention approach and the CLINICAL implications of the biopsychosocioeconomic (BPSE) model for the TREATMENT of sickness and disability into their world. The strange thing is: as a physician, I am nearly alone here. There is a dearth of physician input much less actual leadership here.
The biggest message that physicians can bring: some people on SSDI today have been over-disabled by the care they got in today’s inadequate and inequitable medical and disability benefits systems. The right care could let them be less impaired and more functional — or even “un-disabled”. This is particularly true of people disabled by common everyday conditions that DON’T disable most people. The impairments they have today might have been avoided or minimized and their work disability could have been prevented by APPROPRIATE treatment in a RESTORATIVE system of care. Today’s systems OVER-emphasize bodily anatomy and physiology (and over-aggressive treatments such as opioids, injections, and surgeries that often actually worsen outcomes). Today’s systems UNDER-acknowledge the influence of the individual’s brain (memories, knowledge, thoughts, beliefs, reasonable concerns, fears, expectations and intentions) on their response to the predicaments that arise when symptoms appear that interfere with daily life and work . As a result, treatments that have been shown to effectively address these things are NOT AVAILABLE. Chronic pain is the poster child for this failure. It really DOES MATTER whether the reason a person cannot perform a function is because of (a) paralysis or a fused bony joints or (b) protective self-limitation and deconditioning. Sometimes BOTH impairment and work disability are preventable – or remediable.