Commentary From CareWorks Medical Director Dr. Chrisanne Gordon, MD
“Listen to the patient, they will tell you the diagnosis.”
These words of wisdom spoken from Sir William Osler often fall on deaf ears as today’s physicians work from computer screens and ask pre-ordained questions for the brief examination allotted for office efficiency and maximum payment. It’s true in the workers’ compensation world as well as the private health care establishment. In workers’ compensation, this is often taken much further, as payment is allotted for the “allowed diagnosis,” and any alteration of the diagnosis may affect payment.
Personally, I always strive to introduce medical curiosity into a patient’s equation, to give the injured worker a chance to describe the symptoms, especially any change in symptoms and challenge the physician to determine, truly, if this is related to the injury or not.
No one would argue it is poor medical practice to treat “chronic back pain,” for instance, year after decade, with the same series of injections and opiates as utilized in the early weeks of the injury. Medical curiosity forces us to ask the following questions. What has changed? Has the pain increased in intensity? Have you experienced a loss of function? Is the pain no longer controlled with the medication and activity regimen? Why do you think you are worse?
All these questions lead to a diagnostic series and a conclusion that may not be related to the original slip and fall injury of years ago. Aging, diabetes, obesity, cancer, fractures and degenerative changes all play a role in the natural course of a human life and it is primarily in the workers’ compensation world where physicians can suppress curiosity and stick to the tried, true and paid treatment plan year after year.
Don’t our patients deserve better?
Shouldn’t they be listened to on a regular basis, and become informed patients about their condition and the natural progressive course of aging? Shouldn’t they be invited, from the very first visit, to take part in regaining function and decreasing pain through the natural course of healing? If medically indicated, shouldn’t they be referred to their family physician for a complete work-up to rule out other possibilities, potentially critical possibilities such as metastatic cancer or myeloma?
Physicians in the workers’ compensation field owe our patients the gift of medical curiosity. All our patients deserve to be heard, diagnosed and treated, either within or outside the system, for the actual etiology of their symptoms. All of us, including case managers, employers and risk managers must listen to the patient. It is our responsibility and it is their right.
Dr. Chrisanne Gordon, MD
CareWorks Medical Director
Chrisanne Gordon, MD received her Doctor of Medicine in 1977 from The Ohio State University where she graduated with honors, Summa Cum Laude. Dr. Gordon trained at The Ohio State University in the Internal Medicine Department. After her internship and residency, Dr. Gordon practiced for four years as an emergency room physician. In 1983, Dr. Gordon became the Director of the Occupational Health Center for Memorial Hospital of Union County in Marysville, Ohio. She completed her residency in Physical Medicine and Rehabilitation from The Ohio State University Hospitals. Since 1988 she has been the Director of Physical Medicine at Memorial Hospital of Union County.
Dr. Gordon obtained Board Certification in 1989 by the American Board of Physical Medicine and Rehabilitation. She has been in private practice in the area of Physical Medicine and Rehabilitation in Columbus and Marysville Ohio from 1988 to present. She has also served as CareWorks Medical Director since 1997. Due to the majority of injuries in workers’ compensation being musculoskeletal in nature, her area of expertise is invaluable to providing direction on medical treatment for the population that is served. Her role and responsibilities include:
Assisting with the development and quality assurance of policies and procedures for medical management and return to work services;
Developing medical policy and utilization review criteria;
Evaluating utilization and provider practice patterns;
Overseeing clinical decision-making aspects of the medical management program;
Overseeing the CareWorks’ Alternative Dispute Resolution (ADR) process and panel of ADR physician reviewers/examiners; and,
Having periodic consultation with practitioners in the field.