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Your workers’ compensation costs are soaring! What can you do? In a panic you call the nearest occupational health clinic and ask the Doc., “What can I do?” With a matter-of-fact and confident tone, the doctor recommends a “pre-placement physical exam” for all your new-hires. Doc assures you that a $45 - $65 physical exam will “ensure” that you are hiring fit and healthy people. Doc then adds,”…and if you really want to be certain, for another $40 - $50, I can do some functional capacity (strength) testing for your general laborers, and, for your clerical positions, I can do some nerve impulse testing (for carpal tunnel syndrome)”.
In other words, just pay the doctor and clinic $100-$120 or more per each of your new-hires and you will be able to find out who is fit to work and who is not. Baloney. For the most part, clinic pre-employment physical exams are a sham and a scam! Why? Unfortunately, with today’s HMO-PPO climate in medicine, hungry health care providers and medical clinics are capitalizing on the fears of employers. Clinics are running up big bills for fancy exams and special physical tests for new-hires that are of little to no value except to them (the providers) as a more lucrative income stream.
In recent years some new “wrinkles” have been added to the physical examination process and marketed as “breakthrough” technologies that identify persons who are most apt to develop specific injuries or have an inability to perform the job adequately. Again, that’s baloney. They are all but useless in accomplishing that!
Here are five (5) of the more commonly used “forecasting” techniques, along with only a limited discussion of their usefulness (or lack of)...
Faulty Forecasting Technique #1- CLINICAL PHYSICAL EXAMINATION
Very rarely is a previously undiagnosed or unknown physical impairment “discovered” by a physical examination. It is a well-established medical fact that the most accurate method for determining the likelihood of future injury of illness is based on an individuals historical (health history) evidence. If a physical impairment exists at all, it is much more likely to be found on the health history (NOT the actual physical exam) portion of the physical.
Today, on virtually all basic clinical exam forms, this vital health history is NOT detailed nor is it specifically designed to uncover available information that is truly useful.
Faulty Forecasting Technique #2- LUMBAR (BACK) X-RAYS
In fact, most persons with low back pain have “normal” X-rays! AND, most people with spinal abnormalities that appear in an X-ray do NOT have back problems! The American College of Radiology and the College of Occupational Medicine have both publicly rejected the usefulness of X-rays for this application. Additionally, this unnecessary exposure to radiation can be dangerous.
Faulty Forecasting Technique #3- FUNCTIONAL CAPACITY (STRENGTH) TESTING
Extensive studies indicate very little correlation between the results of “strength testing” and the probability of later injury to the individual being strength-tested. The actual “strength” test at a clinic simply confirms ONE thing: whether or not the individual can lift “that” much weight that “one” time (on that one day, at that one time/date). It does NOT measure the individual’s endurance capabilities in lifting “that” same weight (e.g., 10, 30, or 100 times) in any given day. As importantly, it does NOT predict the long-term physical or health impact on that specific individual as a result of any repetitive effort in lifting “that” same amount of weight they “proved” that they could lift (“once”) during their clinical strength test! All in all, there is NO scientific validity to the information gathered by this all but useless and expensive examination. Why even pay to have them done on your new-hires?
Faulty Forecasting Technique #4- LABORATORY ANALYSIS
Abnormal findings from laboratory analysis (blood work-up, urinalysis) are rare in an individual not previously experiencing symptoms. Again, why even pay to have that done on your new-hires?
Faulty Forecasting Technique #5- WORK SIMULATION TESTING
Work simulation will measure ability at the present moment (usually while the applicant is exerting maximum effort- they do want the job, after all!). Like “strength testing”, it does not measure endurance, which is intrinsically necessary for a useful assessment of the worker.
THEREFORE...AS AN EMPLOYER, HOW SHOULD YOU PROCEED TO BEST ENSURE THAT EMPLOYEES ARE “PHYSICALLY FIT” TO PERFORM A PARTICULAR JOB?
Fortunately there is a very viable option. Earlier, we referenced the accepted medical fact that 90%+ of all diagnoses are made based on historical (health history) evidence. Considerable research has been carried out in the field of worker injury and illness. Board-certified authorities in occupational medicine – including our own Dr. Michael Wald at OHS - have been able to identify several health history factors which predispose an individual to future disability. Among others, these factors include past surgical intervention, past neurological involvement, past pain episodes, past repetitive or prolonged disabling events, and past psychosocial attitudes and behavior. In other words, a specifically designed health history questionnaire based on these multiple, pertinent factors in the applicant's PAST is the answer to a more meaningful and useful evaluation for pre-placement decisions. A more in-depth and comprehensive health-history from your new-hire will also provide you with the most useful assessment information available to identify persons at probable risk for future disabling illness or injury.
This type of risk assessment system, in addition to documenting past medical incidents, can also prognosticate what is recognized as “chronic disability syndrome” (sometimes referred to as “delayed recovery syndrome”). This syndrome, alone, could be responsible for the largest percentage of your workers’ compensation claims. Employees experiencing delayed recovery may do so intentionally or not, but, in a specially designed health history questionnaire, very specific “red flags” can be identified to alert employers in advance. Employers can then implement early intervention in a case and affect earlier employee recovery, earlier return of function, and an earlier return to work by the employee- RESULTING IN A SIGNIFICANT REDUCTION IN TOTAL COSTS OF EMPLOYEE REHABILITATION.
What is both exciting and enticing about utilizing this type of worker risk assessment system is its comparative ease of use and relative inexpensive cost. For companies with multiple locations there is the added advantage of uniformity and consistency in physical assessment results, since all results are funneled through and analyzed by one source (OHS) and supervised by one Nationally Board Certified Occupational Health Physician. That consistency is impossible when, instead, you are working with multiple clinics and multiple physicians with multiple interpretations of findings.
The worker risk assessment questionnaire can be completed by the employee at the time of hiring and evaluated by a specifically educated occupational physician according to established occupational medicine protocols and A.D.A. considerations. There is no need to refer the applicant to a medical clinic unless there are specific indications for doing so, as determined from the assessment.
Further, when the risk profile is analyzed against a properly described job analysis (one listing the job’s “essential” functions) it can serve as documentation to measure the extent of any “restriction” or "reasonable accommodation” needed. Those of you knowledgeable about the Americans with Disability Act (A.D.A.) will recognize this very obvious advantage in making hiring or placement decisions that are legally defensible.
(end of article) NOTE: OHS, Inc. offers a superb, low-priced physical assessment program to employers as an alternative to "clinic exams". See "Find out about..."
