Download Living Enabled or Living Disabled: Beliefs and Choices

Living Enabled or
Living Disabled:
Beliefs and Choices
Chris Brigham, MD
Brigham and Associates
Goals
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Identify key questions.
Contrast exceptionally abled vs. needlessly disabled.
Explore concepts critical to our understanding.
Examine how beliefs and incentives drive needless
disability.
Discuss solutions to combat needless, self-serving
disabling and to empower individuals to live full, joyful
lives.
© 2012 Brigham and Associates, Inc.
Questions – Answers?
1. Why do people with the same problem have different
experiences with disability?
2. What is disability and how much of this is
preventable?
3. How important is work?
4. What is the impact on “needless disability” on the
individual and society? What are the human and
financial costs?
5. How do beliefs contribute to living abled or living
disabled?
© 2012 Brigham and Associates, Inc.
Questions – Answers?
6. How do entitlement systems and our own actions
contribute to needless disability?
7. Are our workers’ compensation and other entitlement
systems fatally flawed?
8. How do we empower individuals to live full lives?
9. What would our world be like if disability was the
exception and we all lived full and productive lives?
10. What actions could we take as individuals and
organizations to empower and stop needless
disabling?
© 2012 Brigham and Associates, Inc.
What We Know
Studies and data document that:
1. Disability is increasing, despite improvements in
medical care.
2. Costs associated with disability, both human
and financial, are increasing.
3. Unemployment is hazardous to physical, mental
and social-well being.
4. Workers’ compensation and disability benefit
systems are fraught with challenges.
© 2012 Brigham and Associates, Inc.
Pain ≠ Impairment ≠ Disability
Disability
Pain
Impairment
© 2012 Brigham and Associates, Inc.
Why Work?
• Work is of central importance to human existence.
• Absence from work is detrimental to person’s
physical, mental and social well-being.
• The studies and data supporting these conclusions
are irrefutable.
© 2012 Brigham and Associates, Inc.
Contrasts and Lessons Learned
Challenged and Empowered
vs.
Needlessly disabled
• Individual
• Complex web of other participants (systems,
organizations and individuals)
© 2012 Brigham and Associates, Inc.
Challenged and Empowered
• Live productive, vibrant lives
despite challenges
• Inspirational
• What can we learn?
© 2012 Brigham and Associates, Inc.
Nick Vujicic
• Born with no limbs
• Motivational speaker “Life Without
Limbs”
• Author Live Without Limits: Inspiration
for a Ridiculously Good Life
• Lessons learned:
– Dream big
– Improve your own attitude regarding
obstacles in life
– Use to the best of your ability the gifts
you have been given
– Proper way of thinking can lead to an
abundant life
© 2012 Brigham and Associates, Inc.
Jessica Cox
• Born with no arms
• Pilot
• Black-belt
• Lessons learned:
– The way we think has a
greater impact on our lives
than our physical
constraints.
© 2012 Brigham and Associates, Inc.
Bethany Hamilton
• Survived shark attack, lost her arm
• Continues to surf
• Soul Surfer
• Lessons learned:
– Strive to be the best at
whatever God calls you to do.
© 2012 Brigham and Associates, Inc.
Mile Stojkoski
• Paraplegic post motorcycle
accident
• Completes cross country
ultramarathons in a regular
wheelchair.
• Lessons learned:
– Persistence
– Challenge yourself
© 2012 Brigham and Associates, Inc.
Stephen Hawking
• Amyotrophic lateral sclerosis,
nearly completed paralyzed
• British theoretical physicist,
cosmologist, and author
• Lessons learned:
– Physical disabilities do not limit
your mind
© 2012 Brigham and Associates, Inc.
Patrick Henry Hughes
• Born without eyes and unable
to straighten his arms and legs
(unable to walk)
• Highly talented multiinstrumental musician
• Lessons learned:
– Persistence
– Challenge yourself
© 2012 Brigham and Associates, Inc.
Michael J. Fox
• Age 30 diagnosed with Parkinson’s
disease
• Activist for research on finding a
cure for Parkinson’s.
• Lesson learned:
– Find the optimistic view, no
matter what the situation.
© 2012 Brigham and Associates, Inc.
Craig McFarlane
• Blinded at age 2
• Accomplished athlete
• Lesson learned:
– Do not consider your
limitations as a handicap,
they may be your new
uniqueness and strength.
© 2012 Brigham and Associates, Inc.
Grant Korgan
• Paralyzed in 2010 snowmobiling
accident
• Achieved goal of reaching South
Pole via SitSki
• “Although my body was broken,
my spirit never will be. I am
unbreakable!”
• Lesson learned:
– Focus on positivity and
thriving.
– Be a survivor
© 2012 Brigham and Associates, Inc.
Needlessly Disabled
• Perceived or labeled as
disabled, without significant
objective supporting
evidence.
• Lessons learned:
– Beliefs define who we
are
– Root causes of disability
are multi-dimensional
– “Biopsychosocial”
approach is necessary
© 2012 Brigham and Associates, Inc.
Risk Factors for Delayed Recovery,
e.g. “Needlessly Disabled”
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History of prior claim and delayed return to work
Workers’ compensation or personal injury litigation
Job dissatisfaction
Biopsychosocial issues
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Personality disorders
Somatization
Depression
History of childhood abuse
Drug abuse
© 2012 Brigham and Associates, Inc.
Contrasts
Living Abled
Impairment > Disability
Positive (Optimistic)
Needlessly Disabled
Impairment / Disability
Impairment < Disability
Perspective
Negative (Pessimistic)
Strength
Emphasis
Positive
Job / Life Satisfaction
Negative
Problems
Barriers
Challenges=Opportunities
Self
Locus of Control
Forgiveness
Reaction
Independent
Relationship
Weakness
Others (Blame, Entitled)
Revenge, Obsession
Dependent
Active
Physical
Inactive
Gratitude
Feelings
Anger
Joyful
No
Health (Function)
Affect
Symptom Magnification
Focus
© 2012 Brigham and Associates, Inc.
Depressed
Common
Litigation (Adversarial)
“Peeling the Onion”
© 2012 Brigham and Associates, Inc.
Beliefs
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Expectations that we
have concerning a
situation
Define how we see the
world
Many are formed in
childhood
Adopt beliefs conveyed
by authority figure
Profound impact on
injury, illness and
disability
© 2012 Brigham and Associates, Inc.
Neuroplasticity
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Our brains and nervous
systems change, structurally
and functionally, as a result of
input from the environment
Positive – athletes (muscle
memory) and musicians
Negative – addiction and pain
© 2012 Brigham and Associates, Inc.
Adverse Childhood Experiences
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Common
Long-term, damaging
consequences: behavioral,
psychological and medical
© 2012 Brigham and Associates, Inc.
Personality Disorders
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Enduring patterns of
inner experience and
behavior that deviate
from those expected by
the individual's culture.
Present in 31% - 64% of
individuals with chronic
pain
Often not recognized or
ignored
© 2012 Brigham and Associates, Inc.
Medicalization
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Process by which
conditions and problems
come to be defined in
treated as medical
conditions and therefore
subject to medical study,
diagnosis, and treatment.
Permits health care
providers and drug
companies with an income
opportunity.
© 2012 Brigham and Associates, Inc.
Medical – Psychological Silos
Medical
• Perform medical testing
to identify pathology
• Define a diagnosis
• Provide treatment to
achieve MMI
Psychological
• Identify a behavioral or
psychological syndrome
Courtesy Michael Coupland, Integrated Medical Case Solutions
Biopsychosocial Model
• Identify and manage all
aspects that impact
health and disability,
without “medicalizing”
© 2012 Brigham and Associates, Inc.
Biopsychosocial Model
of Health & Disability
Lifestyle: Exercise, Smoking, Alcohol
and Drugs, Obesity / Diet
Work Attachment / Age
Chronic Pain
&
Disability
Behavior
Depression / Anxiety
Personality Disorders
Hx of Childhood Abuse
Perceived Injustice
(retribution owed)
Fear Avoidant Behavior
(Guarding)
Courtesy Michael Coupland, Integrated Medical Case Solutions
Catastrophic Thinking
What Hurts Us?
• Pain
– Pain Disorder
– Chronic Spinal Pain
• “Naming Stuff”
– Cumulative Trauma Disorders
– Fibromyalgia
• “Mind Stuff”
– Psychological Labels
– Post Traumatic Stress Disorder
© 2012 Brigham and Associates, Inc.
Our Healers?
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Iatrogenesis – “First Do No Harm”
Inappropriate Diagnostic Evaluation
Inappropriate Diagnoses
Failure to Educate Patient
Inappropriate Treatment
– Misuse opioids
– Misuse other medications and device, compounded by
physician dispensing
– Unnecessary therapies and surgeries
• Faulty Causation and Apportionment Analysis
• Faulty Work Ability Assessment
• Faulty Impairment and Disability Assessment
© 2012 Brigham and Associates, Inc.
What are their beliefs and how can
they interfere with recovery?
Physician
Other Providers
Employer
Injured worker
Judge
Claims Adjuster
Attorneys
© 2012 Brigham and Associates, Inc.
Family
Others
What Are Possible “Solutions”?
• Society
– Recognize the problems and the drivers, and educate all
stakeholders
– Prevent childhood adverse experiences
– Shift focus from disability to ability, disease to function, and
the medical model to the biopsychosocial model
– Promote concept of personal accountability
– Promote concept that “Work is Healthy”
– Hold all stakeholders accountable for their actions
– Ban advertisements by pharmaceutical and device
manufacturers, physicians, and attorneys
© 2012 Brigham and Associates, Inc.
What Are Possible “Solutions”?
• System
– Provide universal health care coverage?
– Avoid litigation and attorney involvement by use of
alternative dispute resolution processes
– Pay physicians and other participants for outcomes, not for
procedures
© 2012 Brigham and Associates, Inc.
What Are Possible “Solutions”?
• Employers
– Recognize core issues
– Provide “healthy” workplace, both in terms of culture and
safety
– Focus on health productivity, with stay at work and early
return to work interventions
© 2012 Brigham and Associates, Inc.
What Are Possible “Solutions”?
• Claims Professionals (Insurers and TPAs)
– Understand the core issues, with awareness by all
participants
– Manage claims proactively, efficiently, and with integrity
– Involve quality health care providers
– Avoid unnecessary adversarial positioning
– Identify early risk factors for delayed recovery (e.g. use a
screening tool) and intervene
• Attorneys
– Reduce the need for your involvement
© 2012 Brigham and Associates, Inc.
What Are Possible “Solutions”?
• Health Care Professionals
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Understand the concepts and apply them
Use evidence-based practice guidelines
Educate patients and avoid “medicalization”
Do not provide harmful testing and treatment (especially
opioids and certain surgical procedures)
Assess causation and apportionment on basis of facts and
science
Assess work ability on consideration of risk, capacity and
tolerance
Assess impairment and disability, only if qualified
Work cooperatively
© 2012 Brigham and Associates, Inc.
What Are Possible “Solutions”?
• “Patients”
– Understand you are responsible for your life and your beliefs
drive your experiences
– Reframe injury or illness as part of the human experience, an
opportunity for growth, and not a barrier
– Focus on your abilities, not symptoms, pain and limitations
– Be physically active
– Choose joy and happiness
– Demand quality health care
– Focus on staying at work
– Avoid involving attorneys or others who may adversely
impact your long-term well-being
© 2012 Brigham and Associates, Inc.
Action Steps
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Demonstrate integrity.
Focus on function and ability.
Recognize the power of beliefs.
Take personal and organizational steps to reduce the
needless human and financial costs associated with
disability.
• Demonstrate in your actions a focus on living a joyful
and productive life.
© 2012 Brigham and Associates, Inc.
[email protected]
www.cbrigham.com
Chris Brigham, MD, Brigham and Associates, Inc.
970 N Kalaheo Avenue, Suite C-312, Kailua, HI 96734
808-254-9400
© 2012 Brigham and Associates, Inc.