The toxic effect of the system - more in some jurisdictions and less in others

Blog - The toxic effect of the system - more in some jurisdictions and less in others

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 first few sentences might be “I got back pain as I had to do a heavy job – I asked for assistance but they ignored me”.

There’s a difference in the texture in consultations between the different jurisdictions.

My way of describing this is the angst level of patients. How much do they complain about their situation, how negative are they, does one get the sense they are “pissed off” with the system? How do they present in the examination? In complex cases people can feel a greater need to convey their illness. The might emphasise their pain level, they may demonstrate pain behaviours (non-verbal expressions of their pain such as grimacing, holding their back, etc.)

My non-research based guesstimate of average angst levels are: Victoria 3 to 5/10, South Australia 6 to 7/10, and Western Australia 2/10. (0 is no angst, 10 extremely high).

Patients in Western Australia seem more straightforward. They are more likely to have a defined recognisable medical condition, and be more relaxed in the consultation. They are more likely to have looked you up on the internet, or at least tell you they have. They seem to have a better understanding of what is expected of them, and what is likely to occur in the case. It’s not universal but is pretty consistent. They are more likely to be engaged in self-management strategies. There’s still angst and frustration but it’s less than other jurisdictions.

In South Australia, it’s the opposite. More complaints, gradually spreading areas of pain, less self-management of their condition, and less clarity about their future. More ‘merry go rounds’. Lots more frustration.

Victorian patients, by and large, are somewhere in between.

There are a couple of great papers that explore the negative impact of the system on people.

The "toxic dose" of system problems: why some injured workers don't return to work as expected.

The authors postulate that common problems that occur within comp systems build up – calls not returned, the person’s health problem questioned, delays in treatment approvals, negative comments from co-workers, etc. – and that the negative effects build up to a ‘toxic dose’.

Preventing Further Harm to the Harmed

Lack of respect for the system means workers aren’t trusted, medical providers don’t want to be involved, so people get lower quality medical care, and people feel a need to ‘prove’ their ill-health.

The issues that occur seem to be universal, but more in some schemes than others.

There are many differences and one can’t say exactly what causes what. There are different cultures in each state. There are more job opportunities in WA; people seem more entrepreneurial in WA.

The privately-run insurance system seems to work better. Case managers are more likely to return your call – that’s a good starting point! Case managers are more likely to know the claimant/patient and are more likely to have a case management plan. The system seems to work better. Talk to doctors: they complain less and they seem more likely to cooperate. Not all, but most. There’s more consistency in independent reports: fewer cases where one doc says there is little wrong and another says the person is totally unfit.

Return to work rates are better in WA than Vic and SA, and the system seems to be doing less harm to people. At least that is how it seems from the doctor-patient interaction.