The Fetish of the Objective Finding

Abstract

Pressure is mounting for clinicians to rely solely on objective measures when evaluating workers with possible work-related disease. These measures are intended to largely supplant the worker's history as sources of information regarding diagnosis, work relatedness, and extent of disability. While seeming to promote more accurate and neutral evaluation methods, the underlying agenda is to reduce business costs by denying work-related illness and disability. Promoting the view of occupational health as the province of technical experts, the campaign for the objective finding silences workers as unqualified to comment. The methods proposed to enhance objectivity also suffer from significant specific shortcomings. To resist efforts to fetishize the objective finding, clinicians need to recognize the subjective elements of objective methods as well as the objective value of subjective data. This requires recognition of the central role of workers and histories in the clinical evaluation process.

The structure and process of workers’ compensation systems and the role of doctors: A comparison of Ontario and Québec

“…Several studies have found that access to healthcare for IW may be negatively affected by physician aversion to the gatekeeping role [Ison, ; Lax and Manetti, ; Lippel, ; MacEachen et al, ; Kilgour et al, ,], including bureaucratic requirements [Kosny et al, ; Kilgour et al, ] and increased scrutiny [MacEachen et al, ], that sometimes affects their treatment choices because of the need to provide “objective findings” [Ison, ; Lax, ]. A study of Ontario doctors treating patients covered by WC found they resented the time required to complete the forms, the repeated requests for more and more precise evaluations and being ignored after providing advice on treatment or functional abilities [MacEachen et al, ], findings confirmed in our study.…”

Examining the completeness of occupational injury and illness data: an update on current research

“…Some safety incentive systems reward workers who do not report injuries with money, material goods, or recognition. [8][9][19][20][21][22][23][24][25] Members of active unions may have support for safely reporting health problems. Workers with insecure immigration status, limited permission to work, or lack of marketable job skills are particularly vulnerable to the dangers of reporting.…”

“…The compensation pays for only a portion of lost wages, often does not cover the first several days lost, usually takes several weeks to arrive, and may be contested or denied altogether. 20,[37][38][39][40][41][42][43] Workers who are aware of these obstacles or who are unfamiliar with wage replacement benefits may depend on paid sick time to recover from workplace injuries or illnesses. Thus, lack of sick leave benefits, especially common in nonunion employment, may prevent these workers from missing work.…”

“…Obstacles to workers' compensation at the levels of employers, clinicians, and workers have been reviewed extensively. 20,[38][39][40][41] Filing compensation claims can raise employers' premiums, while charging ordinary health insurance coverage usually does not. Employers typically pay all compensation insurance costs with no co-payments by employees.…”

“…67 Compensation may be denied, and is typically contested, for health problems with multiple potential causes or long latency periods. 20,68 Charges to workers' compensation may also lead to job loss, difficulties in obtaining future employment, and social stigma for the patient. 9,38,39,69,70 Self-employed workers are not covered by workers' compensation.…”