Physicians must be patients' advocates.

• Position: Disability - Cases of disability caused by work-related injuries - Brief Article - Statistical Data Included

"Everyone loses when workers are injured or disabled for long periods of time. The insurer, employer, and society suffer the economic losses, while the employee suffers the individual loss from time off work, decreased income, and costly medical bills. For the employee, a bilateral carpal tunnel syndrome surgery can cost as much as $75,000 in direct and indirect costs. The opportunity to change the current lose-lose situation to win-win lies in prompt treatment and early return to work," emphasizes Mark J. Melhorn, an orthopedic surgeon with The Hand Center, Wichita, Kan.

"Obviously, disability management represents an area of medicine that has large financial impact upon society. Depending upon one's definition of disability, between 35 and 46,000,000 Americans can be labeled as disabled," Melhorn points out. "The definition of disability and the determination of who is disabled continue to challenge governments and adjudicating bodies. Thus, the definitions of disability expands and contracts more along political and ideological lines than according to any clear physical determinations."

Occupational health incorporates the concepts of ergonomics, return to work, and medical management of disability. "In occupational medicine, it is not only necessary to fix the worker; one must have an idea about how to improve the workplace to prevent future injury," Melhorn stresses. Prevention comes in three formats:

* Primary prevention keeps injuries and illnesses from occurring. This is the most difficult type and requires an instrument or tool to measure risk.

* Secondary prevention is the traditional health care provided by physicians. The patient (employee) develops symptoms and sees the doctor, who provides a diagnosis such as carpal tunnel syndrome and begins medical treatment.

* Tertiary prevention is designed for those injuries that have reached advanced stages and threaten to produce significant side effects of complications. Most workplace injuries do not reach this level because early...