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 problems.

Regardless of the anti-discrimination laws, many employers have workarounds to avoid taking on employees who declare their health issues. How employees present the history of their condition is coloured by how they think it will affect them.   

An example of how things can go in the workers compensation scenario:

A year or so ago I saw a woman who has had neck problems for about 15 years. It was claimed the problem was the result of a nasty fall at work. The patient described how the neck problem developed after the incident, and how she had no history of neck problems prior to the fall.

Recognising that taking a history some 15 years after the incident was an unreliable way of assessing whether the injury had contributed, I suggested that early records of her treating practitioner’s notes should be reviewed.

The two sets of physiotherapy notes painted the picture. 

The first physiotherapist’s notes documented the same condition for three years prior to the fall. It was localised pain on one side of the neck, with referred pain into a section of the arm. The severity of the pain and frequency of treatment was the same before and after the fall.  

Two years after the fall she started attending a new physiotherapist. After a few consultations the new physiotherapist asked her if she had had any prior injuries. She mentioned a fall which occurred in the course of her duties two years prior, and the physiotherapist then attributed her neck problem to that fall.

She seemed to be a good lady, and had continued her job for many years after the incident. The system had paid for her continued treatment for over a decade. After work relations between her and her employer deteriorated, she stopped work as a result of her pain and a common law claim ensued.  

As the second physiotherapist attributed her condition to work, she lodged a claim and the claim was accepted. She presented well and worked in a professional role. Multiple reviewers accepted her statements.

It became evident that the physio, presumably trying to be helpful, took only a cursory history and made the connection.  From that point forward, it became fact.  

Finding the Facts

The history on which the system commonly relies is imprecise. If we want to address this problem properly, we need to do more ground work. The best information comes from the treating health practitioner or doctor’s clinical notes. Accessing medical records is always preferable to asking a patient to remember. Records predating and around the time of the condition developing tend to be the most useful.  

The accessing of patient records certainly needs to be balanced against privacy issues.  There are various ways in which the clinical records can be reviewed. The sharing of printed patient records is fast and easy, however as a patient, would you want your consultation records detailing menstrual problems or difficulty with intercourse to be shared widely?

As an independent reviewer, I am often asked whether work has contributed to an injury, often years after the event. The verbal patient history of prior problems is not reliable, but we frequently rely on it during assessments. Instead we need to do our groundwork more thoroughly.

 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 problems. Regardless of the anti-discrimination laws, many employers have workarounds to avoid taking on employees who declare their health issues. How employees present the history of their condition is coloured by how they think it will affect them.   

An example of how things can go in the workers compensation scenario:

A year or so ago I saw a woman who has had neck problems for about 15 years. It was claimed the problem was the result of a nasty fall at work. The patient described how the neck problem developed after the incident, and how she had no history of neck problems prior to the fall.

Recognising that taking a history some 15 years after the incident was an unreliable way of assessing whether the injury had contributed, I suggested that early records of her treating practitioner’s notes should be reviewed.

The two sets of physiotherapy notes painted the picture. 

The first physiotherapist’s notes documented the same condition for three years prior to the fall. It was localised pain on one side of the neck, with referred pain into a section of the arm. The severity of the pain and frequency of treatment was the same before and after the fall.  

Two years after the fall she started attending a new physiotherapist. After a few consultations the new physiotherapist asked her if she had had any prior injuries. She mentioned a fall which occurred in the course of her duties two years prior, and the physiotherapist then attributed her neck problem to that fall.

She seemed to be a good lady, and had continued her job for many years after the incident. The system had paid for her continued treatment for over a decade. After work relations between her and her employer deteriorated, she stopped work as a result of her pain and a common law claim ensued.  

As the second physiotherapist attributed her condition to work, she lodged a claim and the claim was accepted. She presented well and worked in a professional role. Multiple reviewers accepted her statements.

It became evident that the physio, presumably trying to be helpful, took only a cursory history and made the connection.  From that point forward, it became fact.  

Finding the Facts

The history on which the system commonly relies is imprecise. If we want to address this problem properly, we need to do more ground work. The best information comes from the treating health practitioner or doctor’s clinical notes. Accessing medical records is always preferable to asking a patient to remember. Records predating and around the time of the condition developing tend to be the most useful.  

The accessing of patient records certainly needs to be balanced against privacy issues.  There are various ways in which the clinical records can be reviewed. The sharing of printed patient records is fast and easy, however as a patient, would you want your consultation records detailing menstrual problems or difficulty with intercourse to be shared widely?

As an independent reviewer, I am often asked whether work has contributed to an injury, often years after the event. The verbal patient history of prior problems is not reliable, but we frequently rely on it during assessments. Instead we need to do our groundwork more thoroughly.