Blogs by ‘Dr Mary Wyatt’

Dr Mary Wyatt | Published: September 27, 2016
Does WorkSafe have a problem?
Today Gabrielle has written about the Victorian Ombudsman's report into management of workers compensation claims in Victoria, published September 2016.
The report outlines the experiences of around 65 claimants under the workers compensation scheme in Victoria, and the difficulties they faced. The report also takes into account views of scheme participants, many who came forward to express their concerns about how the scheme operates.
WorkSafe's response is published on page 164 of the detailed and concerning...
Dr Mary Wyatt | Published: March 18, 2016
Metrics are one of those things we love to hate. "You can't manage what you can't measure" is often quoted to justify putting a number on every activity in the attempt to increase effectiveness. 
But the response noting that there are "Lies, damn lies, and statistics" shows what tension we have about measuring things.
Perhaps it is not the fact that we are looking, but rather the perception that we don't always look with understanding that causes the negative reaction.  
Why is it that we often get metrics wrong?  Problematic metrics either measures an...
Dr Mary Wyatt | Published: March 18, 2016
Last time we discussed why metrics are often considered problematic by the people doing the work that the metrics are intended to measure.
So where does this leave us? There are three kinds of metrics that make sense: measures of purpose-driven activity, measures of effectiveness and measures of unintended consequences.
Measures of purpose driven activity look first at what we want to achieve. Suppose we decide we want to focus on client satisfaction, and we believe that responsiveness to enquiries is a key factor.
That sort of goal requires us to measure...
Dr Mary Wyatt | Published: September 18, 2015

This graph is from Professor Charlotte Leboeuf-Yde, who is a sophisticated researcher in this area.

If you are in your 20s, the chance of some degree of degenerative changes is about 10%.  If you are in your 70s the chance is about 70% or 80%.


When someone develops back pain, it is common to see their condition reported as an aggravation of a pre-existing underlying degenerative change.    


But what does this statement mean? 


There is some correlation between back pain and the presence of degenerative changes, but the correlation is weak or poor....

Dr Mary Wyatt | Published: August 25, 2015
Patient histories are by nature unreliable as people’s recollection skills are never perfect. We are human after all. My estimate, based on research and everyday experience, is that the history of long term health problems is only about 50% accurate.
I’m a doctor but have also been a patient - not very often, but often enough to know that my recollection is just as poor as the patients I see.  
I’ve been in situations where I’ve been asked about my past history and forgotten it. Only a day or two later have I realised that I should have mentioned x or y, relevant...
Dr Mary Wyatt | Published: July 28, 2015
First of all, policy makers need to get interested in this area. Taking the lead on this is a significant initiative, so I think it is up to the policy makers to map out a plan. They need to involve a number of subject matter experts, including research specialists and people with the capacity to translate research, and it would need to be collaborative.
Medical specialists can also make a substantial contribution. Organisations such as the Faculty of Occupational and Environmental Medicine possess the knowledge but not the funding ability. 
The Dutch have created a...
Dr Mary Wyatt | Published: July 13, 2015
If a person believes their work contributed they may be understandably worried that going back to that activity / job will do more harm. 
Basing assessments of work contribution on beliefs, including the employee’s beliefs and the employer’s beliefs, can cause all sorts of complications.  
Employee beliefs
We are a determinist people.  We look for a cause for whatever health problem we face. The mother who has a child with cerebral palsy looks for what might have occurred during the pregnancy to cause the condition. The person who gets cancer looks to...
Dr Mary Wyatt | Published: June 30, 2015

Today I want to talk about Occupational Epidemiology.

That might include studying an epidemic, such as the spread of the AIDS virus. It might involve studying the occurrence of asthma, which groups of people get asthma, and what factors might increase the risk of asthma in the various demographics.

Occupational epidemiology studies what happens to the population of people who are working. For example, do brick layers get more shoulder problems than bank managers? Which chemicals tend to induce asthma? Which body movements increase the likelihood someone will experience neck or...

Dr Mary Wyatt | Published: June 01, 2015

Doctors who conduct pre-employmentDoctors who conduct pre-employment assessments say that around 10% of people report previous back soreness. This is in conflict with the studies which tell us at least 70% of the population have had prior back soreness. 

For many, an individual’s past back pain back pain won’t interfere with their ability to do the job. They also know that if they declare their back pain, they are less likely to get the job. 

Whatever the rules say should happen, many employers believe they can avoid claims by discriminating against people with certain health...

Dr Mary Wyatt | Published: May 26, 2015

The challenge we face is that a person’s recollection of their health problems is not reliable.  

I’ll use back pain as an example.  

Studies of large groups of people tell us that back pain is common. 20% or more of the population has a long term back complaint, where they experience some level of back discomfort or soreness on most days.  More than 30% of people experience intermittent episodes of back pain. Only about 30% of the working age population have never experienced back pain.

New and better quality studies suggest that people can move from one of these groups to...

Dr Mary Wyatt | Published: May 19, 2015

The impact of work on a particular health problem can be a contentious issue, and the assessments are often not done well (IMHO).

Disputed claims cause can cause significant grief. They are more likely to be expensive, and return to work rates are worse.  This is a big issue and needs to be addressed, but is not currently being tackled at a policy level.  

Employees feel aggrieved if they believe work has contributed to their condition and their claim is denied. After they have an accepted claim for a few years, receiving advice their claim is being terminated on the basis that...

Dr Mary Wyatt | Published: March 24, 2015

I recently saw a man in his mid-30s who’d worked in steady employment since leaving school, mainly as a sheet metal worker. He developed a back problem, a disc prolapse with sciatica, and underwent spinal surgery. He couldn’t go back to his previous type of work, but youth and many years of work ahead suggests support to get back into a different long-term line of work is a priority.

Yet there had been almost no focus on rehabilitation. A realistic approach would be 6 to 18 months of retraining, moving him into a different line of work: OH&S, a youth worker, AutoCAD work, becoming a...

Dr Mary Wyatt | Published: March 10, 2015

A United States study published on March 14 found when patients requested specific medications from the treating doctor, they were much more likely to be prescribed that medication.¹

Actors were sent to see doctors about musculoskeletal problems. Some of the actors requested medication they said they had seen advertised on TV, or medication friends had taken, while some actors were instructed to leave any medication up to the doctor. Those who requested specific meds were much more likely to get that medication.

This doesn’t come as a surprise. Pharmaceutical companies can...

Dr Mary Wyatt | Published: September 30, 2014

I’m Victoria based. Once a month I travel to South Australia and Western Australia to see patients. Over the last few years it has been fascinating to compare different compensation systems through the lens of the patient. There is a notable difference in how the schemes affect people.

When patients provide a history they are essentially tell their story. How the system is treating them impacts how they tell their story.

For example, patients going through a common law process commonly start their history differently. Instead of “I started getting a sore back two years ago”, the...