If you can't prove it medically, should you get paid for it?

Great Debates
1

In another GD thread, a conversation arose about what the standard should be for a person (specifically) being able to claim compensation through Worker’s Compensation. I don’t want this to be limited to WC, so use any examples you like.

My position on this is yes. We should deny it exists, at least for monetary purposes, if it can’t be proven to exist.

This doesn’t mean that a doctor should ignore it, or science should assume it is nonsense. But for monetary claims, I believe that if it can’t be documented, it doesn’t exist.

But I’m willing to be talked down from this ledge.

2

How do you document/prove hallucinations, depressions, mania, schizophrenia, suicidal thoughts, etc.?

What about migraines?

3

Here is what happened to me:

Several years ago, I was involved in a car accident. I’ve lived in pain ever since. My doctors have diagnosed “soft tissue damage” which can’t be medically proven in the way that a broken bone can be. Nor can it be fixed.

I’ve been though about fifty sessions of physical therapy, have seen about 15 different doctors and specialists, and I’m on medication for the pain. My doctors have told me that it’s unlikely I’ll ever get better. I have insurance, but each year I spend a lot of my own money on meds and copays. (To refill all of my prescriptions costs $425 out-of-pocket. That’s every 90 days.)

The monetary aspects are only one part of it. My whole life has been affected by this. My job, most certainly, but I have understanding co-workers who try to take up my slack. Sitting in a chair and leaning over a desk is painful, so I really have trouble with my sculpting. I can’t even ride a rollercoaster, and I sure as hell can’t go whitewater rafting again with my friends. I had to hire a housekeeper because scrubbing my bathtub or using a vaccuum cleaner is bad enough to make me want to cry. Just about the only thing that doesn’t cause pain for me is laying on the couch, but I don’t want to do that. I’m only 29. I’d like to have a life.

When my attorney asked me to name a figure, I said I wanted $50,000. This will help defray some of the costs that I’ll have to pay for the rest of my life. (But not if I get liver damage from all of the meds-- a situation we’re watching closely.) I’m not trying to exploit this situation. I’m just trying to live with the permanent damage which was inflicted on me through no fault of my own.

But can I prove I’m actually in pain? No. The chiropractor I saw had a very vague report in which he claimed he could detect physical damage. The deep-muscle massage therapist and my physical therapists said they could feel how tight my back muscles are, but I suppose I could be faking that as well.

Medical science can’t always find what is wrong with a person. They can make guesses and assumptions based on symptoms, but sometimes they’re at a loss to point to a specific area of trouble. Take my heart condition, for example. It’s extremely difficult to detect, even for a specialist. It took me four doctors before one finaly found it. Now, she’s moved out of state and my new cardiologist is skeptical of her diagnosis. He wants to run all of the tests again. (Oh goody!)

Think of it this way: psychological trauma can’t be proven, either, but should rape victims be barred from suing the person who assaulted them?

4

From what I can tell, doctors still violently disagree about whether there is a Gulf War Illness. But I think veterans deserve the benefit of the doubt and should be compensated for that disability.

5

Hmm. I was thinking in terms of “You did this to me, now pay up” though I didn’t limit the OP in that way.

6

They should be able to sue for the things that can be proven, the rape itself, the physical trauma.

If two women get raped and one is devastated and one is pretty okay, the latter has just as much claim as the former, in my opinion.

7

Wow, seems like all my answers to life’s questions lately have been “it depends”. :smiley:

Here’s another thing I thing should be left to the discretion of judges, and why it’s important to elect good judges.

A few years ago, I rear-ended a woman, and her car rolled forward and rear-ended another car. We all got out, paramedics came “just in case”, and everyone declared they were fine, no need for medical care, we’re all good here, let’s let the insurance companies sort it all out. A couple of years go by and on the very day before the statute-of-limitations runs out, I get a call from my insurance company that the woman in the front car (the one hit by the person I hit) had filed a lawsuit against me that day.

Arbitration (required in our state) revealed that she’d had documented back pain for more than five years *before *the accident, requiring monthly chiropractic and physical therapy visits. She claimed the accident exacerbated her pain, and she had to quit her job as a nurse because of it - but she didn’t quit the job until more than a year after the accident. She never saw a doctor, nor did she increase her chiropractic or PT visits. She did not ask her hospital for lighter-duty work or administrative work, she just quit because she could no longer lift 300 pound patients. It was obvious to everyone - me, my lawyers, the arbitrator, and even her lawyers, that this woman was an opportunistic bitch. I would honestly not have had a problem had her behavior been in accord with her claims, but it was just too blantant for words.

She lost the suit, as I think is only just.

However, if in a similiar scenario, the claimant had sought medical care, had worked to find employment she could do, had increased doctor or PT visits and documented and increase in pain, I would say she’d probably be credible, and should be compensated for her loss of income and increase in medical fees, even if there was no way to show soft tissue pain on a medical test.

But it should also be noted that just because pain doesn’t show up on a test, that doesn’t mean a doctor can’t often tell when you’re faking. There are signs - blood pressure, heart rate, breathing rate - that *can *be measured, and others - sweeping hand gestures rather than specific pointing to indicate “where it hurts” - that doctors recognize as indicators that a patient is not being truthful.

8

I agree with you. If there is no way to prove damages than there is no way to assign a value or weed out the scammers. In regards to mental illness, that can be documented and proven by a specialist but I don’t see why someone would have a cause to sue for hallucinations or schizophrenia.

9

There are any number of medically diagnosable conditions with few if any objective signs. Moreover, the objective documentation of the existence of a condition may say little or nothing as to the severity of that condition for a particular individual.

I often muse over historic trends to ascribe such subjective-symptom-based conditions to either physical or mental causes. The person who might have been diagnosed with “hysteria” or “the vapors” 150 years ago, may be diagnosed with chronic fatigue syndrome or fibromyalgia today.

Certain diagnoses tend to come in and out of vogue. For example, environmental sensitivity syndrome seemed to enjoy a brief popularty in the 90s, but seems to be less common now.

And with respect to many conditions - CFS and fibromyalgia for example - reputable individuals differ as to whether to attribute them to physical or mental causes. Is fibromyalgia physical or mental? What about fibromyalgia with somatoform overlay? Whichever it is, does that make any difference as to whether it is compensable?

There are a whole heck of a lot of diagnosable conditions out there that are generally accepted by significant portions of the medical community. Just in the area of pain syndromes you have chronic pain syndrome, RSD, somatoform disorder, fibromyalgia, myofascitis, etc. Just about any symptom complex should be able to have a diagnosis assigned to it. Of course naming a condition says nothing as to whether its cause can be identified or whether it can be cured.

In my opinion, I think that for a condition to be compensable - either in litigation or under most welfare/benefits programs - it should reflect a condition that is generally recognized by the medical community. Not something some quack comes up with and purports to treat.

And then, compensation requires an assessment of the individual’s credibility, to ascertain whether they actually experience symptoms and limitations of the severity they allege.

JMO.

10

Wherever there is a system there is always going to be someone who tries to take advantage of it. I admit I might be a bit prejudiced on this subject, but it seems grossly unfair to penalize people who are genuinely suffering because the system might be abused by a few. You can say the same about any social welfare program as well: should we eliminate food stamps or Medicare because some people might try to run a scam? Where does that leave the legions of people with legitimate needs?

I’ve always been of the opinion that we shouldn’t base policy on the lowest common denominator. There is no way to create systems which are completely fraud-proof and every hurdle we put in the way just harms the people who really do need help-- the scammers will find a way around it but the honest people will just face miles of red tape and frustration.

Where does all of this leave me? For the rest of my life, I’m going to have to bear the expenses of my prescriptions and other treatments whether or not I get any kind of settlement. Am I just shit-out-of-luck in your book because I can’t point to a broken bone or a pinched nerve on an X-ray? Can you imagine what your frustration would be if you were in my shoes? (To tell you the truth, I wish I had a broken disk or something like that because that can be treated.)

I’m never going to be able to enjoy swimming again, or even something as simple as tending to my flower garden. I can’t help my husband paint the deck this spring. I can’t carry a laundry basket. I can’t even pick up my baby niece. * I have lost something.* I’ll never be the same again, yet that’s not good enough to justify a settlement because I can’t point to it on a chart.

11

Sadly, there are many who argue for the elimination of those programs with that very same reasoning.

:frowning:

12

But sometimes pain is not in an exact spot. I get random bone pain, where it feels like someone took a fireiron or other thin rod of metal and gave me a good crack on a long bone in either thigh. I know it hurts, and that it is on teh long bone, but it radiates and moves around. I have knee damage, and I know where the damage is, but sometimes the pain is low around the patellar tendon and sometimes it is above the knee, and sometimes it just feels like someone is trying to pry my kneecap off with a dull screwdrriver. I have back pain, from spinal damage. I know where the pain is, but sometimes it is not in an exact spot, it can be a burning ‘muscle pull’ type pain crossing several sets of muscles and can radiate from one side of my back to another, and half an hour later, the pain has dulled but now some other area on my back is giving me the gyp [because I have been gimping around trying to hold a position that keeps the hurting part of my back immobile so it wnt hurt as much, and now a different spot has taken over the pain generation.]

It is just like any chronic pain sufferer will attest to. You can have good days and bad days, and it can even go from good to bad in a matter of minutes. I have had days where I woke up fine, and an hour later I have to crawl to the bathroom because I was silly and sat on the floor and now I cant get up until I can get to the grab rail in the bathroom.

13

I know, it’s not an exact science. A good doctor never diagnosis on a single symptom, he’ll look at the whole picture and make his best educated diagnosis.

That’s just one of the symptoms from my orthopedic assessment text. I won’t share them all because that just makes it too easy for drug seekers. Not that I’m not sure they could find it elsewhere on-line, but just because I don’t want to be the one to tell them.

14

Ah, one of the central questions of my life. About a third of my practice is worker’s compensation and employee health issues, and in fact I’m speaking at a conference this weekend on this very topic.

The vast majority of work-related pain, both acute and chronic, will show no objective signs. Managers, WC people, and the like seem to think that objective signs=real pain and no signs=faking, but it just isn’t true. Sometimes there are patterns of pain, motor or sensory deficits, or even radiographic findings that allow me to make my description sound more scientific, but in the end there usually isn’t much real science to it.

The managers think the doctor should be able to tell who’s faking and who isn’t, but we really can’t. Good physical therapists are a lot better at it, with their particular training and increased time spent with the patient, but in a single 15-minute office visit I can only pick out the most obvious ones. It’s made harder because very few people are honestly pain-free and faking it entirely; most of them really have the sort of pain they’re describing, it just isn’t nearly so bad or debilitating as they describe.

Which leads to another question: who can say how bad pain is? You can try to quantify it, say, by asking how long they’d be able to stand before the pain became unbearable, but it’s a meaningless question out of context. They can probably stand longer at $12/hour than they could at $5/hour, and for $100/hour they could probably stick it out all day. I’m not even sure that’s dishonesty; I can stand for hours at a good concert without any trouble, but boring surgeries during medical school gave me miserable back and foot pain in pretty short order.

This is a fundamental flaw in the worker’s compensation system. If you get paid $18/hour to mine coal and $0 to sit at home, you’d. If you get paid $18/hour to mine coal and $12/hour to sit on your ass, there isn’t that much incentive to mine coal. I don’t know what to do about it, since there isn’t really a fair way to remove that disincentive, but it makes this a lot harder.

My answer to the OP is a resounding “maybe”. Obvious fakers should get squat, and people with obvious objective pain should get what’s coming to them. Unfortunately, almost everyone falls in between.

15

Spot on, DoctorJ!

You’ve progressed nicely over the years from callow med stud to sharp young attending who’s obviously going places! It’s been fun to observe that.

16

Insert “find a way to get back to work” as appropriate, along with a warning about keeping the bottle of Sangiovese next to you while editing long posts.

Thanks–that means a lot.

17

You made my hair stand on end. I had that exact same accident and roughly the same outcome. It was settled for not much money a few months ago but it made my life hell for 18 months. She claimed That 2 mile and hour tap from the chain reaction disabled her for life. In reality, she had been out on Workman’s comp for almost 10 years and sued someone else since.

It feels pretty bad to know that a complaint is bogus but have them resort to an unprovable diagnosis and tell you to pay up.

18

Yesterday in the local newspaper (didn’t make it to its webpage):

20 years ago, this guy was in a car crash. He had glass all over his face, the doctors had a lot of fun taking it all out. All?

FFWD to a few weeks back. This guy has been complaining about pain on his cheekbone right below the left eye for 20 years; X-Rays don’t show anything; he flinches when touched but the toucher can’t feel anything. Someone has the idea of using a different kind of scan, of a type that didn’t exist 20 years ago.

The scan shows “something” but the doctors can’t really tell what it is. Anyway, they decide to take it out.

Turns out to be a squarish fragment of car glass, about 1/4inch to a side.

Like the guy said “what still pisses me is how many times I’ve been told I was imagining things, just because they didn’t have a way to detect it.”

19

Well, my ten years experience in ortho certainly contradicts your “very few people are honestly pain free.” After seeing hundreds of surveillance videos and being duped many times, yes, there are many scammers and no, they really aren’t having much if any pain at all. They are having dollars signs and milking it for all it is worth and what it is worth is a 3% impairment with no objective findings if they milk it long and hard enough.

That 3% costs the insurance companies hundreds of thousands of dollars in unnecessary medical care, supplies, medications that probably get flushed and tests that all come out negative. Oh, but they are “hurting”. Hurting enough to unload an entire moving van or do moves on a basket ball court that Michael Jordan would envy.

Oh, but of course, they can’t work. Can’t stand more than an hour without having excruciating pain. Can’t bend or twist or stoop or drive a car. Certainly can’t go back to their manual labor job. E.v.e.r.

Ahhh, but a Jacuzzi would make me feel so much better, doc. Or a new pillow top mattress. How bout one of those massage chairs? That should do the trick. Now if you would just sign here.

Cynical? You betcha.

20

As someone with an interest in health quackery and related scams, the OP raises additional issues for me.

What if that person with persistent pain unrelieved by traditional therapy says that they get relief through past life regression, Ayurvedic herbs, using an electrical zapper to kill their undetectable internal parasites, by having a maze constructed in their backyard or via any of the vast number of supplements, “cleanses” or interventions that have hit the market in recent years? Should our insurance plans (or national health coverage) pay for these things, given the absence of clinical trials showing their safety and effectiveness (most rely on personal testimonials)?

I find it very difficult to quantify an individual’s physical or psychic pain, and lean toward being relatively generous with therapy (even non-conventional types, if they have reasonable scientific justification) in spite of the difficulty of “proving” that a patient has a difficult-to-diagnose condition - assuming that condition has a solid foundation in medical science to begin with.

There are some parents of autistic children who are convinced that their kids’ problems stem from vaccines containing small amounts of mercury-based preservatives - despite the overwhelming weight of scientific evidence demonstrating the lack of any connection. Do we compensate all those families (into the billions of dollars, most likely) based on a link likely never to be shown? Should all Gulf War Syndrome claims likewise be accepted?

Who winds up paying in the end when dubious conditions are accepted as real? Or more precisely, what health care for documented ills is not provided when money is diverted to treat or compensate for these questionable syndromes?