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If you haven’t had a lot of experience with the medical care delivery system before,
you might feel mystified or upset when dealing with your medical providers.
This section will help prevent that. It briefly describes how medical care for an injury is usually delivered – so you are aware what should happen, can recognize when things are not going along in the normal order, can ask good questions and are prepared to do your part to make the right things happen. This section briefly reviews these topics:
- Selecting the physician,
- Importance of the first medical visit (initial treatment),
- Follow up care,
- Referral to specialists and sub-specialists,
- Functional rehabilitation.
Selecting the Physician
- An injury is usually a surprise. If it is uncomfortable or severe, it demands immediate medical attention,
and you will have to go a facility that can handle walk-in patients. After initial treatment has been provided, subsequent care (or “follow-up care”) is usually scheduled by appointment,
possibly with a different physician.
- For information about how to obtain initial treatment, select a physician, and get treatment authorized, see
How the Process Gets Started – What to Expect and
Your Role in Your Medical Care and Recovery.
- Patients often change physicians between the first and second appointments. Typically this
happens because their usual physician was unavailable on the day of injury, and the patient simply wishes to return to their regular doctor.
Also, emergency rooms usually do not provide any follow-up care, and the
role of “treating physician” will then pass to another practitioner who
takes over care. In today’s world, many people do not feel like they
have a “family doctor” so they are happy to stay with whatever doctor saw
them first.
- Note that after your first visit, you must use a medical care
provider certified by BWC in order for your bills to be paid. If
you do not, you will have to pay for the care yourself. See the BWC
website for a list of certified providers. You can also just ask the
provider whether they are certified by BWC.
Importance of the First Medical Visit or Initial Treatment
- The main purpose of the first medical visit after an injury is to sort out what has just happened and take care of whatever immediate issues need addressing. For workers’ compensation injuries, this visit is especially important because the facts documented in the medical records for this visit are key to the BWC’s decision whether it is a work-related injury
- whether to "allow" it.
- The usual order of events during the visit is as follows, although details may vary from medical office to office, and some items may be forgotten. In order to assure the smoothest possible workers’ compensation process,
you can help make sure all the required steps happen.
- The first step is to register as a patient with the administrative staff who will ask for identifying information and
ask whether the patient thinks the injury is work-related. If so, the appropriate forms will be put in the
medical "chart" (the file) for the physician to fill out. If not, the claim may not be reported timely
to BWC!
- Next, the practitioner will begin by asking a few quick but careful questions about how the injury happened and the patient’s other medical problems; do a physical examination;
and perhaps take a few tests such as X-rays, or collect blood or urine samples. Ideally, the patient clearly describes exactly how the injury occurred and the doctor makes note of that.
- Based on the information gathered during that process, the practitioner will then either make a preliminary diagnosis
(determination of what the medical problem is), or make a list of possible diagnoses – and determine the cause of the problem. Often this thinking will happen while he or she gets to work tidying things up: washing a wound, stopping bleeding, putting on a dressing, putting in stitches to close an open wound, splinting a broken bone, or removing something that has gotten in the eye.
- Once that is all finished, the patient will be given:
- Instructions on how to care for their own injury.
- A prescription for medications if needed.
- A note for the employer that recommends appropriate
activities and describes any medical restrictions
(things you cannot or should not do) or removes the patient from work entirely for a period of time. The note also includes the date of the next scheduled visit (if any).
- A plan for follow-up care – the date of a next appointment or the type of a practitioner to see. (Some medical offices will actually arrange the follow-up appointment as a courtesy).
- After the patient leaves the clinic, the rest of the paperwork is done. The physician will write down the key information gathered during the visit (which creates the medical record
required for ongoing treatment, and for BWC and the MCO to administer the workers' compensation claim). If
the practitioner believes the injury is work-related, he or she is then supposed to fill out a form to report a work-related injury and send it to the Bureau of Workers’ Compensation (BWC). If follow-up care will be provided by a
different physician, a copy of the medical record may be sent on ahead
to them.
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Follow-up Care
- If the nature of the injury is self-evident (something like a burn, or a sprained ankle), the follow-up medical care plan is to continue to care for the injured tissues, to relieve pain and other symptoms, and to rehabilitate the injured body part. The physician may send the patient to other healthcare professionals
("refer" them) for additional services. In the workers’ compensation system, the most common referrals are to specialist
and sub-specialist physicians (like orthopedic surgeons) and to physical or occupational therapists
(PTs or OTs).
- If there is still any uncertainty about the diagnosis, the physician’s follow-up care plan may involve continued observation to watch for further developments or additional testing to gather more information. Common tests for muscle, bone and joint problems are X-rays, CAT scans and MRI. If symptoms indicate a possible problem with nerves, commonly used tests include measurements of
"nerve conduction velocity" and EMG.
Specialist or Sub-Specialist Referrals
Treating physicians tend to refer patients with workers’ compensation injuries to specialists or sub-specialists for three main reasons:
- A specific symptom or feature of the condition needs a further diagnostic procedure that requires specialty training. The most common examples are a referral to a radiologist for an imaging procedure
(e.g. X-ray), or to a neurologist for testing of the nervous system.
- A specific symptom or feature of the condition raises the question whether surgery is needed. Specialists have extra training in evaluating whether surgery is needed and performing the actual surgical procedures. In workers’ compensation injuries involving the spine, bones, or joints, treating physicians tend to refer to orthopedic surgeons or neurosurgeons when the question of possible surgery arises. Sometimes the answer is
"no, surgery is not needed."
- A pattern of treatment which normally results in healing has failed to produce the expected result, so a second look by expert eyes is needed. Specialists and especially sub-specialists have extra training in diagnosis and treatment of unusual or difficult cases. Sometimes the answer is that nothing is wrong, healing just takes more time for some people. And sometimes, the reason for the slow healing is not related to the injury at all, but to something else that needs attention. It might be another medical condition such as diabetes or obesity. Or it might be the patient’s failure to do their part in the recovery plan due to non-medical issues. In either case, healing the injury will require attention
to the other issues.
Functional Rehabilitation: Physical and Occupational Therapy
- Tissue injury and pain can make movement difficult. Lack of movement can make joints stiff and weaken muscles. Being unable to move normally means that certain activities of daily living become difficult. And inactivity can lead to deconditioning, which means getting out of shape.
- Physical and Occupational Therapists (PTs and OTs) specialize in helping people relieve pain, rebuild muscle strength and regain range of motion in their joints. They have had special training in evaluating and treating musculoskeletal conditions. The most effective therapists usually provide hands on treatment in the clinic for a limited time (a few weeks at most), and then start teaching the patients how to care for themselves.
- "Passive" treatments like ice and hot packs are best used during the first few days while tissues are swollen and inflamed. After that, the best treatments are active, requiring effort on the part of the patient.
- In addition to musculoskeletal rehabilitation, both physical and occupational therapists, especially the latter, are trained to help patients who have impairments to find alternate ways to accomplish things they want to do, such as dress, cook, drive, or work.
Restoring function and independence is usually the main goal of therapy in
workers’ compensation injuries.
Prepare Yourself
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