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Monthly Archives: June 2009

Is Return To Work the Best Measure of Healthcare Outcomes?

As a relative newcomer to the field of occupational medicine, I’ve become fascinated with the significance of return to work from an illness or injury. When an employee returns to work, especially on a timely basis, most observers would agree that this constitutes a “good outcome.” But that raises a question: what other broadly applicable measures would also constitute a good outcome?

In an era where concern over quality issues in healthcare has never been higher, and attempts to monitor outcomes abound, how, really, are we defining the endpoint of a medical episode and the success of the intervention?

One obvious answer would be discharge from the hospital, but that only signifies recovery from the acute phase of a serious condition. Answers like “When the patient feels better” are subjective and hard to quantify. Often what happens in outpatient or subacute cases is that a string of medical claims is collected and retrospectively analyzed, but that leaves out a vast array of real-life considerations. As “actions speak louder than words”, a patient’s recovery should, intuitively, be pegged to resumption of normal activity.

I have realized that, given the fact that 90% of the people who get sick or injured are working, and that most of them, if properly treated and motivated, resume their productive endeavors when they have recovered, we have, in return to work durations, possibly the single best measure of healthcare outcomes.

If Docs Had More Time, They'd Ask About Patients' Work

clockToday’s New York Times ran an excellent article by Julie Weed titled If All Doctors Had More Time to Listen.  The article puts forth substantive evidence that giving physicians enough time to spend with patients saves healthcare costs in the long run by emphasizing preventive care that cuts emergency room visits and by reducing diagnosis/treatment errors.

I’d like to offer another reason why allowing physicians the time to be thorough is critical to saving healthcare costs. Today’s physicians rarely, if ever, have time to consider the impact of work, and return to work, on patient health. Consider the following points:

  • The “work history” is not usually emphasized as a major component of the history and physical exam, so these considerations are often overlooked
  • There is mounting evidence that the traditional approach to work-related injury — rest and absence from work — is passe, as patients benefit from returning to some form of work as quickly as possible
  • There is a dramatic difference in the approach to specific illnesses depending upon the exact job description and functions

Physicians who have had the time to take a thorough patient history also would have the patient’s work information on record, and would be able to automatically include work history as part of the diagnosis and treatment. There is no question that being able to do so would save on healthcare costs, as recurring medical disabilities are nearly always more severe than the first incidence.

Giving physicians enough time to consider all relevant factors in patient treatment is sound policy. Giving them enough time and encouraging them to ask patients about their work could prevent a great many relapses and more serious health conditions. And that’s good for everyone in the healthcare equation.