Managing Iatrogenic Disability
July 19, 2017
iatrogenic adjective iat·ro·gen·ic (ˌ)ī-ˌa-trə-ˈje-nik: induced inadvertently by a physician or surgeon or by medical treatment or diagnostic procedures
When managing a disability claim with significant iatrogenic contributions, it’s important to remember the word inadvertently in this definition. Many treating providers are drawn to health care because they want to help people. They are trained to advocate for their patients and often are untrained on what constitutes disability. They are also subject to increasing time pressures that are not always be conducive to comprehensive disability evaluations. These factors can produce an unnecessary, although well-intentioned, extension of disability leave. But rest assured, when armed with the proper intervention strategies and information, the skilled case manager can mitigate these iatrogenic factors.
Watch for red flags of iatrogenic involvement in disability claims.
Likely iatrogenic influence:
- Claimant states: “My doctor says I can’t work”
- Claimant states: “When I go back to work is up to my doctor.”
Probably iatrogenic influence:
- Doctor states: Claimant “off work until further notice”
- Doctor states: Claimant “needs to rest”
- Doctor states: Claimant “can can return to a low-stress job”
Additional warning signs
- Provider supports return to work only under different supervisor
- Extended time off work with no change to treatment
- Indication that return to work when symptoms in remission
- Provider recommends obtaining attorney
Once a case with iatrogenic factors is identified, the best way to intervene is simply to communicate with the treating provider. Usually, a little education goes a long way. Validate that disability cases can be frustrating and time-consuming. Reflect an understanding that many providers are pressured to see more patients in shorter periods of time while still managing to establish a working relationship. Often, patients don’t bring up disability or the paperwork they need until the end of the appointment, causing further burden on the providers. Sometimes, completing the forms is the path of least resistance for doctors.
Then, approach the concerns of the case in a respectful and collegial manner. Ask about treatment plans and next steps. Focus on functionality, explaining that disability is about functioning not symptoms. Discuss the standards of care and educate if needed. Emphasize that being away from work is more harmful to a person’s health than helpful, so disability leave should be kept to a minimum for the patient’s benefit. Sometimes, it is helpful to cite research. Let them know that once an individual is away from work for a year, the chance is 2% they will ever be able to sustain gainful employment again.1 Other research shows that work has a positive effect on mental and physical health2 and those who are away from work on a long term basis are more depressed and anxious3, are eight times more likely to attempt suicide4, have higher disease rates (i.e., cancer, heart disease, liver disease, disease of the digestive system, alcohol-related conditions, and infections)5, and generally die sooner.6 In a lot of cases, this type of discussion will help the provider understand the importance of restoring functionality, rather than focusing solely on symptom improvement.
1. American College of Occupational and Environmental Medicine. (August 31, 2005). Preventing Needless Work Disability by Helping People Stay Employed.
2. Argyle, Michael (2013). The Psychology of Happiness, Second Edition. Routledge: New York, NY.
5. Moller, H. (2012). Health effects of unemployment. Unemployment and Health. Wirral Performance & Public Health Intelligence Team.
6. Nichols, A.; Mitchel, J.; & Lindner, S. (2013). Consequences of Long-Term Unemployment. Urban Institute.