The Value of Questions and Early Answers


Gather round, I've got a story to tell - and it starts with a question...

Let me tell you a story good folks. There’ll be no kapows or cape tearing, or rescuing a person hanging from a skyscraper by their fingertips (nope, I’ll leave last week out of it). This story is the stuff of everyday – but it has the potential to be just as dramatic.

We’ll start, as the best stories often do, with a question: If an injury was once work-related, is it always work-related?

To help us find the answer, meet Denise. She’s a 44-year-old accounts receivable administration officer. One day, two years ago, she lent over to pick up a large folder and developed sudden pain in her low back. The problem was accepted as work-related. Her problem abated with time and within approximately two months of physiotherapy the pain had ceased.

Eighteen months ago she developed a further problem during a similar episode. Having just returned to work from annual leave, Denise needed to get out a series of folders from a bookcase. About 20 folders were manhandled. The pain reappeared and once again the condition was accepted as being work-related. Again, it settled over a two-month period.

One month ago, Denise was lifting boxes at home and as she lifted she experienced her third episode of back pain. The two previous episodes were accepted as from her job, so she lodged a further claim. Her doctor advised this third episode was a recurrence of her previous condition.

What follows? The claim is assessed by the claims manager and, after an independent medical review, her claim is not accepted.

Denise is disgruntled; she feels wrong done by and cheated by the system. She feels let down and distressed – factors that won’t make her rehabilitation any easier.

The situation hasn’t been handled well.

In general, we don't deal well with situations such as this. Accepting a condition as work-related doesn't mean that any future episodes will necessarily be from work. Similarly, accepting an aggravation doesn't mean that the whole of the condition is work-related. People might have an underlying osteoarthritis of the knee, twist their knee and it becomes painful. When the flare-up from the twisting episode settles, how do we deal with the underlying non-work related condition?

There are a number of factors that influence the way we deal with this. Stay with me and I’ll talk you through them:


The medicine in this area can be difficult and requires a good understanding of contribution of work to health problems. Traditionally this understanding has been the product of doctors’ own experience. More often than not this proves woefully inadequate.

Research gives us some information, but unfortunately falls short of good quality in many areas. But there is some research available. For example, there is research that tells us that a simple lifting episode does not increase the likelihood of long-term back problems.

It indicates that a relatively minor incident, such as lifting a folder in an awkward position, could result in an acute episode of back pain, but would not be expected to be responsible for long-term back problems or a back problem that occurs in the home environment some two years later.

Communication and setting up expectations

Setting things straight from the beginning would’ve helped. Initial communication with Denise to explain the above would likely have assisted. If, for example, Denise had been advised with her first claim that the incident occurred through work and was therefore accepted as work-related until it settled, she may have had a better understanding for future episodes.

Understanding that the episode at work, which resulted in pain, didn't do any structural damage but will increase the likelihood of future episodes, would have helped her understand the picture that the future holds. She may not have lodged the third claim, avoiding the opportunity for the claim to be rejected, and avoiding the consequent disappointment and unhappiness about the situation.

Better education of health practitioners

Occupational epidemiology, or the study of the health problems associated with work, is a little-understood area. Educating medical practitioners and other health practitioners would result in them being better positioned to give their patients solid advice. Better communication within the treating consultation is likely to avoid hitting up incorrect expectations.

This is a conversation we need to be having more regularly and, dagnammit, I might just start bringing it up more often. If the discussion occurs then we open up people's understanding of the issues. We start to point out that the research information is not well understood, and that practitioners need to avoid commenting on areas they don't understand. Setting up expectations that are not going to be met only causes further problems.

One good question usually begets another and, after all, that’s what good conversation is all about.

Don’t you reckon?