living enabled or living disabled: beliefs and choices chris brigham, md brigham and associates

Living Enabled or Living Disabled: Beliefs and Choices

Chris Brigham, MDBrigham and Associates

© 2012 Brigham and Associates, Inc.

Goals

• 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.


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?


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?

Questions – Answers?


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.


Pain ≠ Impairment ≠ Disability

Pain Impairment

Disability


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.


Contrasts and Lessons Learned

Challenged and Empowered

vs.

Needlessly disabled

• Individual• Complex web of other participants (systems,

organizations and individuals)


Challenged and Empowered

• Live productive, vibrant lives despite challenges

• Inspirational• What can we learn?


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


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.


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.


Mile Stojkoski

• Paraplegic post motorcycle accident

• Completes cross country ultramarathons in a regular wheelchair.

• Lessons learned:– Persistence– Challenge yourself

http://en.wikipedia.org/wiki/File:Mile_Stojkoski.png


Stephen Hawking

• Amyotrophic lateral sclerosis, nearly completed paralyzed

• British theoretical physicist, cosmologist, and author

• Lessons learned:– Physical disabilities do not limit

your mind


Patrick Henry Hughes

• Born without eyes and unable to straighten his arms and legs (unable to walk)

• Highly talented multi-instrumental musician

• Lessons learned:– Persistence– Challenge yourself


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.


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.


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


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


Risk Factors for Delayed Recovery, e.g. “Needlessly Disabled”

• History of prior claim and delayed return to work• Workers’ compensation or personal injury litigation• Job dissatisfaction• Biopsychosocial issues

– Personality disorders– Somatization– Depression– History of childhood abuse– Drug abuse

Impairment / Disability

Perspective

Emphasis

Job / Life Satisfaction

Problems

Locus of Control

Reaction

Relationship

Physical

Feelings

Affect

Symptom Magnification

Focus

Impairment > Disability

Positive (Optimistic)

Strength

Positive

Challenges=Opportunities

Self

Forgiveness

Independent

Active

Gratitude

Joyful

No

Health (Function)

Impairment < Disability

Negative (Pessimistic)

Weakness

Negative

Barriers

Others (Blame, Entitled)

Revenge, Obsession

Dependent

Inactive

Anger

Depressed

Common

Litigation (Adversarial)

Contrasts


Living Abled Needlessly Disabled


“Peeling the Onion”


Beliefs

• 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


Neuroplasticity

• 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


Adverse Childhood Experiences

• Common• Long-term, damaging

consequences: behavioral, psychological and medical


Personality Disorders

• 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


Medicalization

• 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.

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”

Chronic Pain&

Disability Behavior

Ampl

ified

Pain

(Tiss

ue H

yper

alges

ia)Injury-Illness-Pain

CNS Changes

Stress Reactivity

(neurotransmitters)

Cognitive

Affective

Social

Biopsychosocial Model of Health & Disability

Lifestyle: Exercise, Smoking, Alcohol and Drugs, Obesity / Diet

Work Attachment / Age

Depression / Anxiety Personality Disorders

Hx of Childhood Abuse

Perceived Injustice (retribution owed)

Fear Avoidant Behavior (Guarding)

Catastrophic ThinkingCourtesy Michael Coupland, Integrated Medical Case Solutions


What Hurts Us?

• Pain– Pain Disorder– Chronic Spinal Pain

• “Naming Stuff”– Cumulative Trauma Disorders– Fibromyalgia

• “Mind Stuff”– Psychological Labels– Post Traumatic Stress Disorder


Our Healers?

• 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


What are their beliefs and how can they interfere with recovery?

Injured worker

Physician Other Providers

Family

Employer

Claims Adjuster

Judge

Attorneys 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



• 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



• 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



• 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



• Health Care Professionals– 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



• “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


Action Steps

• 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.


[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

http://www.cbrigham.com/

living enabled or living disabled: beliefs and choices chris brigham, md brigham and associates

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