What used to be called pre-employment physicals, I now refer to as physical disposition capacity assessment due, in part, to the July 1992 legislative changes concerning the application of such testing; also, because of the tremendous role that this information plays in the medical management of the employee's working life with the company. This physical will be the foundation for a number of prevention procedures that will help to insure the long-lasting relationship within the organizational structure once the job offer has been accepted and the employee becomes part of the team.
Perhaps this sounds a bit melodramatic, but consider the costs of hiring new people, training them, and the length of time for them to become competent in the tasks required. The skills involved in the rotational process of the plant alone will take some time to master. Therefore, it is in the company's best interest to make the relationship between the employee and itself a long one.
I had mentioned just how important this aspect of the prevention program is, and without an excellent screening process, you are at a serious disadvantage before you begin. I have seen in the screening process I have initiated around the country that at least 40 percent of the population is "contaminated." This population has substantial subclinical findings that border on the edge of pathological conditions. These people are not acceptable for hire if it can be helped. By introducing this contamination into the work force, you are decreasing the health of the overall population of your workers.
The population on the production floor must maintain a certain level of health to remain effective. With many jobs there are periods of overtime, and the added stress of absent employees. The working population must overcome this added stress and still produce the product at the same quality level.
If a DC, for analogy's sake, has a busy practice with a partner and a full staff, how would he feel if fairly often his partner didn't show up at the office because of his undying passion for the game of golf? The stress level would increase for that day, as the work load just doubled. If this takes place often, the toll on the office would be acutely felt. The staff would be affected because of the added stress placed on them; patients would be backed up; the doctor, in response to the added stress, would spend less time with the patients to accommodate the added load. He would become tired and perhaps become abrupt in dealing with the patients. The teamwork would begin to falter and the product (in this case quality care and bedside manner) would decline as would the physical well-being of the doctor and staff. If this occurs occasionally, there won't be much impact, but frequent occurrences will affect the climate of the business considerably.
This analogy is very close to that of the employees and their relation to each other and the management in the course of producing the product. When the atmosphere on the production floor is one of employee absenteeism due to whatever reason, and therefore, antagonism and lack of teamwork, there is added stress on the workers and quality will diminish. This becomes even more evident when the companies go into phases of overtime because of demand cycles for a product. I work with many companies that produce a specific number of their product as needed for that day, and the condition of the worker population becomes absolutely critical at this point. The stress on the line can become unbearable which, in turn, usually affects the quality of the product. This factor puts stress on the organizational staff and the work atmosphere begins to decline and complaints occur. As we all know, stress increases the tension in muscles and that leads to decreased blood flow, which leads to a condition highly susceptible to injury.
I am taking this time for discussion prior to the actual physical because you, as the company physician or member of the company physician's team, need to understand the philosophy of the physical capacity assessment. Historically, it has been a 10-minute procedure that meant nothing at all in the total picture, and even less for what it should have accomplished to begin with. As a matter of fact, you need to ask the company what the failure rate is for their past pre-employment physical and you will find that just about everyone passed. What that has cost that company throughout the coming years is criminal. Instead, you must convey to the company what a tremendous role this procedure can play in the overall health of the employee, which equates directly to the health of the company. It specifically allows the introduction of people that will be able to perform those type of tasks that will be required by the particular physical demand of the company, based on what it manufactures, produces, or services. Once that information is compiled it becomes the basis for a number of procedures that will be initiated throughout the relationship of the employee/employer.
The first procedure that will begin immediately is a work-hardening process based on the data collected in the screening. There will be areas that can be improved upon and even if everything would be problem free (I have never seen that yet), that individual could still be conditioned (work hardened) to be less susceptible to injury and better able to do the job without fatiguing as quickly, thereby improving the quality of that individual's life after work as well.
The second aspect that this information can be applied to is an educational process for individuals to understand their body. This does not mean that the individual is frightened into a lifetime of chiropractic care at that point, if the physician is a chiropractor, nor does it mean the beginning of treatment for borderline high blood pressure if you are an internal medicine specialist. It is the natural tendency of all good doctors to address those issues that they know and believe will be helpful to that individual. We must be careful not to frighten or set the stage for the employee to dwell on a condition just because we, as physicians, "fix that kind of stuff." What we must accomplish is an educational format for individuals that lets them accept a responsibility for that particular situation and hopefully begin to strengthen or reverse that process. This aspect is so important because you will be required to allow individuals into the system with a positive recommendation for hire, that you may not want to in your role as adviser for the company concerning its workers. But if we are to be fair in the screening process, this will happen. You will see there are very few aspects that can actually preclude someone from being hired for a job within the guidelines set down.
The third application for this information would be that of post-injury evaluation. You must remember that when this prevention program is in place and working, the "post-injury" conditions are, for the most part, minor. Things such as tendonitis, arm pain, and upper or lower back pain, are complaints that will surface before they have progressed to a serious pathological condition. This is where the educational phase and conditioning aspect begin to show their importance. Under normal circumstances, an individual would go to the family clinic and explain the problem. We know, historically, that the vast majority of treatment would be basically ineffective for reversing this pathology, and time off, wrist splints, and therapy or steroids would be the course of treatment. The employee would follow those recommendations because of the trust of that individual and not knowing the alternatives. The education sequence allows individuals to go to the company doctor because he is not the typical "bad guy" that the company doctors usually are. Through trust and a conveyance of knowledge, the individual can follow the supervision set forth by the company and see results that they can live with. This allows complete control, the mind set of the employee to let the company doctor successfully treat the condition, and "post-injury" becomes a relatively minor issue. These issues are generally more of a nuisance than a serious issue that many times develops under the traditional course of events.
Occasionally, a situation arises when there is an acute soft tissue injury such as a severe back strain that may involve the disc. If there is a permanency, the individual, I believe, is entitled to it. The baseline data allows a fair interpretation of just how much has been injured and saves a lot of aggravation and expense for all concerned. There are obviously many applications to this data, however, the general idea has been conveyed.
Finally, we must address the application of this accumulation of data as it is applied to that small segment of the worker population (5-10 percent) that takes advantage of the workers' compensation system. I would like to interject that this individual is usually bright and an underachiever. They are frustrated with their choice in life and quickly learn the advantages of "working" the compensation system. It is for these individuals that a tremendous amount of data is collected on everyone. If a solid base of substantiated data that specifies the exact pathology in a claim and the clearly defined extent of the condition, there will be much less likelihood of a large settlement being reached. The work that the attorney will have to do in order to get a settlement will, most likely, be much more than for a similar case without this information. This gives the company a tool to offset demands and generalities as to the "extent" of the permanency. In short, the attorneys will have to work too hard for what they get on cases with that company and will decline or would have not received the big settlements that draw the others in as well.
By establishing clear, concise, and appropriate testing procedures of individuals, several things will take place. When those individuals (referred to as "seekers") seek their fortune with the settlement process, they will not be received with open arms. Let me clarify this: With appropriate and effective testing it is not so easy to substantiate a large settlement demand and get it. Therefore, as your system is tested, it becomes evident in the medicolegal arena that there is too much work for too little return relative to those companies that don't practice dynamic prevention strategy.
This stops a phenomena that takes place in a company soon after a "good" settlement is reached, in which a group of people go to get "their share of the pie." This activity is drastically curtailed when the arbitration rules for relatively minor settlements. Again, if people deserve a permanency, I believe they are entitled to it. It is just that "the seekers" make it hard for everybody as they attempt to glide through life the easy way.
This "solution" is accomplished in a good way that promotes the relationship with the organizational structure and the employees. It actually makes the "bad guys" look bad, and exemplifies that the company really does have the best interest of the employee at heart. However, what is fair is fair, and the company will not allow its people to be taken advantage of. What is really neat is that the company doctor gets to ride the white horse or put on the cape, because they are the guys who put together the information in the first place.
Theodore Oslay, D.C.
DeKalb, Illinois
Editor's Note:
Dr. Oslay will be part of the faculty at the MPI 1993 Advanced Seminar, teaching "Industry Makes the Paradigm Shift Towards Chiropractic," February 28-March 5, 1993 in Kona, Hawaii. For information please call 1-800-359-2289.
