Workers comp / return to work forms

[BoardingDoc]

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Just started seeing a few WC patients. Expected mix of actual injury trying to get better and utter BS.

One just asked me for a work restriction note. She's seen OCC health already and her injury was already 1 month old by the time she saw me. Lumbar radic by exam. No imaging. Wants to try PT before imaging. All reasonable, but I'm feeling like I would just punt this to OCC health. Otherwise, what are people doing in this scenario?

Even outside of the WC realm, I'd probably just be sending back to the PCP as in that case it would be a FMLA or short term disability thing.

 

[Baron Samedi]

$75/page

 

[geauxg8rs]

$75/page

If you want to do it and get paid for it, charge a reasonable amount. If you don’t want to do it charge an unreasonable amount

 

[Agast]

X-ray and PT

6 week follow up

MRI if indicated

Injection if indicated

Whatever you do, make sure no one thinks you’re the “treating physician.”

 

[BoardingDoc]

Thx for the replies. All valid strategies. I think I'm just going to say that I will sometimes write for a few days off of work if we're waiting for an MRI or something but anything more involved than that needs to come from the PCP/Occ health/whoever is quarterbacking care of this issue.

 

[SSdoc33]

Thx for the replies. All valid strategies. I think I'm just going to say that I will sometimes write for a few days off of work if we're waiting for an MRI or something but anything more involved than that needs to come from the PCP/Occ health/whoever is quarterbacking care of this issue.

lol. Good luck with that.

 

[SSdoc33]

You have to be strong willed and do what you think is best. Do not bend to the wishes of the patient. They will eat you alive

 

[Taus]

Thx for the replies. All valid strategies. I think I'm just going to say that I will sometimes write for a few days off of work if we're waiting for an MRI or something but anything more involved than that needs to come from the PCP/Occ health/whoever is quarterbacking care of this issue.

This seems foreign to me. If I’m treating the patient for a work-related injury, as their “on panel” physician, then I am writing their restriction. Modified/light duty, out of work, etc. Maybe it’s different because I am in an ortho practice (ie not “pain”)? This also goes for non-op sports and the surgeons.

 

[Agast]

You have to be strong willed and do what you think is best. Do not bend to the wishes of the patient. They will eat you alive

The happiest day of my job was when I informed them I was no longer accepting workers compensation patients

 

[BoardingDoc]

lol. Good luck with that.

Why good luck?

You have to be strong willed and do what you think is best. Do not bend to the wishes of the patient. They will eat you alive

Agreed. I'm not terribly concerned about that part. I did EM for a decade before this. Pain clinic patients are a joke by comparison in terms of "social degree of difficulty."

 

[BoardingDoc]

This seems foreign to me. If I’m treating the patient for a work-related injury then I am writing their restricting. Modified/light duty, out of work, etc. Maybe it’s different because I am in an ortho practice (ie not “pain”)? This also goes for non-op sports and the surgeons.

So part of my reticence is that I have no idea what is or isn't appropriate there. Lumbar radic lady for example. How long would you keep her out of work? She's already been out for a month before she even met me. She doesn't want interventions and will hopefully actually go to PT. She didn't seem terribly uncomfortable on exam but who knows?

How long does she stay out? When the duration exceeds what work will accept without you doing an FMLA form or disability form, are you doing that then? Referring for a FCE?

To be clear, I'm not trying in any way to criticize your approach, I just wouldn't even know where to begin beyond using vague gestalt.

 

[PM&ARGHH]

in my limited experience, it’s usually better to give restrictions - either activity or hours - and let the employer deal with it, rather than take them out of work entirely. They are usually happy to put someone on light duty vs pay them not to work, and if the patient is not trying to milk it they’re usually happy with that as well.

 

[cowboydoc]

So part of my reticence is that I have no idea what is or isn't appropriate there. Lumbar radic lady for example. How long would you keep her out of work? She's already been out for a month before she even met me. She doesn't want interventions and will hopefully actually go to PT. She didn't seem terribly uncomfortable on exam but who knows?

How long does she stay out? When the duration exceeds what work will accept without you doing an FMLA form or disability form, are you doing that then? Referring for a FCE?

To be clear, I'm not trying in any way to criticize your approach, I just wouldn't even know where to begin beyond using vague gestalt.

Sounds like you should stay away from WC.

 

[Ducttape]

I refer to occ med to make these determinations.

Yes I'm sure ppl will say it's a cop out but having experienced the "issues" with patients angrily accusing me of not helping them is not worth it (I "did" these assessments as an int med resident).

When they ask, I tell them that I am focused on their pain and making them as functional as possible and keeping them out of work is counter to these goals.

 

[SSdoc33]

So part of my reticence is that I have no idea what is or isn't appropriate there. Lumbar radic lady for example. How long would you keep her out of work? She's already been out for a month before she even met me. She doesn't want interventions and will hopefully actually go to PT. She didn't seem terribly uncomfortable on exam but who knows?

How long does she stay out? When the duration exceeds what work will accept without you doing an FMLA form or disability form, are you doing that then? Referring for a FCE?

To be clear, I'm not trying in any way to criticize your approach, I just wouldn't even know where to begin beyond using vague gestalt.

there is no guide book here. it is just what YOU think. nobody knows if somebody can lift 20 vs 50 lbs. nobody pays for FCEs anyway. if a patient likes their job, they will want to get back. if they dont, they will BS you the entire time. nobody knows how long a radic will last. some people can work thru it. some wont get out of bed for 6 months.

the bottom line is that whatever you do, patients will nag you all the time about paperwork, time off, FMLA, etc. its just a huge hassle no matter how you slice it.

just understand that you arent "doing it wrong". it is a case by case basis, even for identical diagnoses. just dont fall for the "can i get off work until next thursday" nonsense.

 

[VA Hopeful Dr]

I refer to occ med to make these determinations.

Yes I'm sure ppl will say it's a cop out but having experienced the "issues" with patients angrily accusing me of not helping them is not worth it (I "did" these assessments as an int med resident).

When they ask, I tell them that I am focused on their pain and making them as functional as possible and keeping them out of work is counter to these goals.

Thank you for this.

There is little that ticks me off more as a PCP than specialists punting patients to me to do FMLA/disability/disabled parking paperwork for the problem they are actively treating.

 

[SSdoc33]

Thank you for this.

There is little that ticks me off more as a PCP than specialists punting patients to me to do FMLA/disability/disabled parking paperwork for the problem they are actively treating.

sh$t rolls downhill.

thank you for being a PCP. it honestly seems like an impossible, thankless job

 

[Agast]

I’m not sure who hates pain doctors more, pain patients or PCPs. Anytime someone mentions pain management online I see them gripe about how we aren’t good for anything because we don’t prescribe high dose opioids for their drug seeking patients. No one wants to be a trash can if they can help it 🤷🏻‍♀️

 

[VA Hopeful Dr]

I’m not sure who hates pain doctors more, pain patients or PCPs. Anytime someone mentions pain management online I see them gripe about how we aren’t good for anything because we don’t prescribe high dose opioids for their drug seeking patients. No one wants to be a trash can if they can help it 🤷🏻‍♀️

My only complaint about y'all, generally speaking, is the fairly rare physician who refuses to do any medication management.

I don't even mean opioids, we have one guy in town who won't even do gabapentin, flexeril, what-have-you. If you don't need a procedure, he's not interested.

 

[VA Hopeful Dr]

sh$t rolls downhill.

thank you for being a PCP. it honestly seems like an impossible, thankless job

I guess. I honestly enjoy it most of the time but I do have a better than average employer and office.

 

[SSdoc33]

My only complaint about y'all, generally speaking, is the fairly rare physician who refuses to do any medication management.

I don't even mean opioids, we have one guy in town who won't even do gabapentin, flexeril, what-have-you. If you don't need a procedure, he's not interested.

i didnt know we lived in the same town?!?

 

[BoardingDoc]

Got another form 30 minutes ago asking for short term disability. Asked one of the spine surgeons about it. Turns out my office actually has someone that we outsource that to. I don't know the details, but apparently I can click a button and make it go away so I'm thrilled.