Disability – it’s not a “medical” condition

A while back I had the pleasure of interviewing Glenn Pransky MD, M.Occ.H., the director of Liberty Mutual’s Center for Disability Research.  As I noted in a post a few months ago;

Glenn is the Director of Liberty Mutual’s Center for Disability Research; he is an occ med physician and has his Master’s in Occupational Health as well and has authored over a hundred articles, research papers, and book chapters.  That’s all quite impressive; what really struck me is how approachable, genuine, and open Glenn is. [my use of his first name is intentional, Glenn is completely without pretension or ego.]

Here’s the first installment of the interview (note I captured this as accurately as possible however any errors are mine) :

MCM: How has the “condition of disability” evolved over the last 20 years?

GP:  [There’s been an] Increase in the amount of health care treatment where it isn’t so clear that it makes people a lot better, along with growth in Social Security disability. More and more people seem to see themselves as permanently disabled.

Workers are staying in jobs longer because they have no resources to retire.

There are more employees with chronic conditions or who are in poor health; [there’s a] wave of baby boomers who are really unhealthy…less routine exercise in our working population. The Return to Work context of 20 years ago has changed, major shift in chronic musculoskeletal conditions is more prevalent today than it was 20 years ago – we are shifting from acute to more chronic disease state.

[Most recently there has been a] Shift from traditional jobs to non-standard work arrangements, contractors, out of house, gig economy etc. Non-traditional work situations are limited in terms of resources for RTW.  The Upside is there is more focused problem-solving on RTW these days than before

MCM: What “causes” disability?
GP: A lot of factors. It starts with a health condition that limits [the person’s] ability to work. Whether it becomes a work loss is due to other factors; whether there are accommodations available, the treating physician’s focus on disability prevention, and whether there is reassurance that the injured worker’s RTW will be safe and supported.

For everyone who’s disabled according to Social Security there’s someone working full time that means there is more [to the disability] than the health condition. Work is better for people, as prolonged disability is bad for your health. Research indicates that even when controlling for the patient’s medical condition, when working age people are out of work, they become sedentary, depressed, detached, and mortality increases.

There are significant opportunities [to mitigate disability]; early positive contact w the injured worker makes a difference; work accommodations offered for temporary alternate duty reduces TTD days by 30%, supervisor response “how can I help”, how can we accommodate” can make a difference of 20% reduction in TTD…Also having a formal policy and consistent approach to it makes a difference.

For insurers- early contact and problem solving research in Australia shows this reduces TTD days.

MCM: What is the role of medical treatment and treaters in disability; causation, prevention, and mitigation?
GP: Providers that are focused on RTW are better for patients and deliver the best outcomes when they practice EBM and communicate w patients on this; there is good evidence that this improves RTW. There are a series of studies from Bernacki in JOEM – more recent ones from WA COHE program…when patients get medical care that does not have a strong evidence base, disability is prolonged. Opioids are a great example.

More to come from Dr Pransky – my quick takeaway is this:

Disability is NOT a medical condition.