Dear Ms. *********,

I returned your call again, and left another message. Sorry I missed you.

Your question is very appropriate, and deserves a solid answer. There are many judgments about a patient's medical care that are made by the physician. However, there are 4 return to work decisions that must be made every time we see one of your employees for an 'on the job' injury. Sometimes these decisions are grouped together and sometimes they are separated by days, weeks, or months. These decisions are also related to the way each of our employer clients specifies their work place, and in your case we have your organization as having light duty available some of the times.

Here are the decisions we need to make.

#1. Does the patient need to be off work totally. This judgment is related to the actual needs of care related to the patient's injury. The patient may need to be hospitalized; the patient may not be able to drive to work; the patient may need to do something at home that he can not do at work like keep his arm or leg elevated. There are many other reasons why a patient should be off work; these are a few.

#2. Is the patient capable of going back to work at a reduced work level which is sometimes called light duty, partial disability, or restricted work. In dealing with workers that have injuries it is our opinion that they do much better if they can get back to work to a light work situation. Having them back to work is actually therapeutic in reducing their total time of convalescence. Because of this all of us work hard to get a patient back to work at the earliest time their injury and the work place setting will allow. This judgment is different for every injury and for every client. We deal with some companies that do not have light duty at all, and I can tell you that it is often times difficult to get a patient ready to assume their normal duties. Most of the time we do not do a functional capacity evaluation for this judgment. This return to light duty judgment is a professional judgment by the physician that is related to three aspects. The injury, the 'will' of the patient, and the capabilities of the work place to have restricted duties have to be combined to make this decision. We usually tell the patient and the client that common sense needs to be used so that if the employee is not able to function properly at the intended level then our work restrictions need to be modified accordingly. Returning a patient it light duty is often times a subjective judgment that needs a lot of fine tuning by the physician for the patient and the employer client.

#3. Returning the patient to full duties can be a very major decision, and that is why we prefer to graduate a patient through a light duty program taking gradual weekly steps of decreasing his work restrictions. Often times the injury is minor and this is an easy decision. However, when the injury is not as minor or when there is doubt in the patient's mind or the physician's mind we have our Occupational Therapist perform a functional capacity evaluation to make sure the patient can do the work that is described by his job description. Most of the time the patient can perform his normal duties before he has reached M.M.I. (maximum medical improvement). Having an employee being able to function at his full duties is also very therapeutic in getting him back to a normal condition of having resolution of his injury.

#4. The last judgment that we make pertaining a patient's injury is the date that he is at M.M.I. (maximum medical improvement). Most of the time this date is related to total resolution of the patient's injury, but sometimes the patient has a permanent disability that needs to be appropriately recognized. Whether the injury is minor or major this is an important judgment for the patient and the employer client. The reason this is important for the employer is that it demonstrates the employer has satisfied the patient's need for medical care which most of the time closes the case. If MMI is not established your employee might have the inclination to feel his employer has indefinite obligations to continue unending medical care. For subscriber's we also do an impairment rating at this time, since your firm is a non-subscriber we do not perform impairment ratings, but we do establish MMI for you which is for your benefit in that you have a 3rd party professional that has declared the injury is resolved and the case is closed.

As a non-subscriber you are free to have any protocols related to the care of your employees. If you have protocols that require different return to work judgments than these four we would be most pleased to follow them. Send me letter or e-mail as to exactly what decisions you want us to make and when you want us to make them and we will proceed.

I hope this note gives you some understanding and explanation as to what is going on. We will continue to work hard giving your employees quality medical care with the intent on getting them back to work as soon as possible. We want to make the best judgments related to the issues of returning your employees to work; if you have protocols different than the above please give them to us for our consideration.

Gregory P. Ennis, M.D.
Medical Director
EcCare Health Centers