Why Is It … ?
Posted by WhiteCoat on July 31, 2008
I had finished putting sutures in the hand of a healthy appearing 33 year old man and was going through my usual spiel about getting the wound rechecked and returning if there was any sign of redness, swelling, pus, increased pain, etc.
Then I asked him whether he needed a note for work.
“No, I don’t work anymore. I’m on disability.”
He appeared normal to me, so I said “Really. Why?”
“I have a seizure disorder.”
I nodded my head and finished his discharge papers.
Then I went back and asked him if there was someone with him to drive him home.
“No – I’m OK to drive. I haven’t had a seizure in a few years.”
With that, he was off to enjoy the rest of the day.
The more I thought about it, the more annoyed I became.
Part of my paycheck is going to go to pay for this healthy young man’s existence for the rest of his life because he has the potential of having a seizure – which hasn’t occurred in a few years.
I started thinking about GruntDoc’s post (through Overlawyered.com) on the fireman who got put on “permanent disability” for a back injury and then placed 8th in a bodybuilding contest 15 days later.
Why is it that the fireman’s case evokes this sense of moral outrage with people wanting to dismember the fireman and to investigate the physician, yet most people don’t bat an eye about patients who are “permanently disabled” for such diseases as seizures, alcoholism, and drug addiction?
Insurance companies and the feds are cutting payments for necessary care but nobody has a problem paying for dubious disability claims? “The powers that be” have created an economic incentive for everyone to become disabled.
It seems that there is a reverse corollary of the phrase “you get what you pay for.”
Those that expect something for nothing will have great difficulty in fulfilling their needs.
Those who provide something for nothing will have a limitless supply of customers.
Davey said
So, how do you get to go on disability?
I’d start by going to see this doctor for my back pain …
Gabriel... said
Knowing what medications your patient was on would be helpful because it’s possible there were other factors involved in his disability diagnosis… I’m not going to defend your ‘case study’ or the weightlifting fireman, but people on permanent disability because of diseases like manic depression don’t get forced off just because they haven’t had a major depressive episode in six months. There are still the behaviours associated with the disease that have to be fixed or overcome. Being designated as “permanently” disabled by the system is most often just a delaying tactic to give the person time to heal without deadlines.
totaltransformation said
Wow, that is pretty horrible.
Miss-elaine-ious said
Sometimes there is a learned helplessness with those with Epilepsy, as the fear of having a seizure and the social stigma places a psychological attachment to the disorder, hence perhaps seeking out social assistance. Also, some business are unwilling to hire a person with epilepsy. It sucks that this healthy person is using the system inappropriately, especially since so many epilepsy advocates are attempting to remove the stigma and have people with seizure disorders lead an active, normal life.
I agree that there is a learned helplessness.
The question is whether someone should be considered “permanently disabled” when they can answer telephones, do desk work, do computer data entry, etc.
Should we be encouraging the learned helplessness by providing someone with an income for doing nothing the rest of their lives or should we treat disability as “unemployment” which is a bridge to keep you afloat between jobs?
HyperAl said
I wonder what the nature of his seizure is and if he is still on medication. I have patients with seizure that are gainfully employed. Actually I have 4, one is a commercial driver that has one episode of seizure and has been off medicine and seizure free for 6 years now. He is back driving a delivery truck. DOT only requires 5 years seizure free, off meds, before you are recertified.
The punishment for screwing the system, especially in cases of Workers Comp fraud, is too benign and is hardly a deterrent. WARNING: The “swoooze” that you heard is the sound of money coming out of your pocket……Who says crime does not pay.
SeaSpray said
Interesting post and comments, particularly your comment to Elaine.
I know two people in my life that are on permanent disability..both always hardworking. My friend has the lungs of a very old woman due to a lung disease. She has the best attitude, and dresses so well and maintains activities to the best of her ability and has said people look at her as though they question her being on disability. But what they don’t see is her having to stay in bed to rest for a couple of days after a shopping excursion to Macy’s in the city. Or how she has to practically live on her inhaler. And now she works minimal hours for her doctor. She has an amazing work ethic and would do way more if she could. She knows this disease could shorten her life and she lives everyday to the fullest with a great attitude.
I am interested in the seizure thing because we have a friend who’s life was turned upside down and ruined due to his seizure disability. It began with a grand mal seizure but went into complex mal..but on a regular basis. he kept trying to work. One day on his way to work he drove into the side of a building and thankfully no one was hurt. They took his license away. He managed to get a ride to work. He worked hard but had seizures at work. he eventually lost that job and then couldn’t get another and living in a fairly rural area had no way to get to work. His marriage fell apart too. He did apply for disability and was denied.
I am floored to hear there are people who still have their licenses and “MIGHT” have a seizure and so therefore qualify for disability. Wow!
Fortunately for him..a nun who happened to live in the apt above him recognized the gross error in this and they went to court and he was not only awarded disability but back disability too.
The seizures have done physical damage over the years and no one would want the burden this man carries.
At first they thought maybe this was caused by an injury from birth but it was later determined that it probably came from an injury incurred while on the job with the volunteer fire dept and he was hit in the head with a swinging ladder.
WC what you say about telephone work etc..you make a valid point. If a person can land these jobs and be productive in the work force then I think that is a great idea. Now they may not be able to live on it but it might be a great way to supplement. Also…good for self esteem, etc.
The only problem is the way it is set up.. like with social security…people lose their disability if they go over a certain amount of hours. Talk about killing incentive!
Gabriel... said
“…when they can answer telephones…”
Being on disability, even permanent disability, doesn’t mean you can’t work. The Ontario Disability Support Program allows people who are permanently disabled to receive a salary up to CDN$600/month and still receive a full cheque. Anything past that and money is deducted according to a formula. Even after someone finds full employment they are still in the ODSP system for up to a year so they can receive benefits like dental, drug and eye care. If, at anytime during that year, they lose that job then the ODSP payments start again.
Each case is reviewed regularly.
“The question is whether someone should be considered “permanently disabled” when they can answer telephones, do desk work, do computer data entry, etc.”
Actually, I think your question is whether this man (not the fireman) you encountered is screwing the system somehow because he said he hasn’t had a seizure in over a year but is still receiving disability benefits. Maybe there are other factors involved… surely there are medical disabilities which have seizures as a symptom which can be dealt with without getting rid of the disability?
Nurse K said
FYI–Congress has long since changed the law making is so alcoholism and drug addiction no longer make you eligible for social security disability unless you’d qualify whether or not your were an alcoholic or drug addict. For instance, if you have liver cancer probably due to being an alcoholic and the cancer has metastasized to the bones and you are wasting away and too encephalopathic to work, you’d get disability even if you continued to drink every day.
Anne said
My lazy, obese, sister-in-law got on a diet a few years ago and was losing weight nicely. Then she said a lawyer told her that if she hadn’t lost weight, he could get her on disability. Guess what? She is now morbidly obese and on disability, and loving every minute of it. I don’t know how my brother can stand her but I guess that’s their business. That’s how some people get disability.
Family Med Resident said
I had a patient come in a few weeks ago requesting her disability forms be filled out. She was in her 50s, well-groomed, and seemed to have no trouble talking, walking, or with any other motor skills. I asked her why she was on disability and she said it was because of breast cancer. She had a mastectomy and radiation therapy, no chemo, FIVE YEARS before! She was in complete remission. No mets ever, and not even any swelling of the arm on the side of the mastectomy. She had no symptoms of depression, had absolutely no other medical problems, and was on no medications.
I filled out the form, stating that there were no limitations to any of her activities. I guess we’ll see what happens next.
SeaSpray said
My friend that has the serious lung disease had to PROVE her disability and obviously she did with he test results and I don’t know what else.
Some one was laughingly telling me recently that it is easy to get those handicapped stickers for the close parking spaces. With the knee pain I sometimes have i am sure I would qualify..but I’ll tell you what..I’d rather crawl in before I would succumb to getting one of those.
I don’t understand…if you live like you’re disabled you’ll act disabled and what the heck quality of life is that?
And those parking spaces are there for people that NEED them and they should use them. I am talking about the people who abuse the system in whatever capacity. And I am just resistant to giving in to any pain I have like that and realize that for all my joking and sometimes believing I am a wimpette with pain… I actually do endure a lot because I don’t ever want to give in to it..ever.
Iis Kusaeri said
It is very hard for us to have the disability. So for the man who thought he could drive well, wow!!! Fantastic….
The Happy Hospitalist said
My two favorites. Two actual patient responses.
1) I’m on disability for fibromyalgia
2) I can’t tell you why I’m on disability. Most patients wont’ tell their doctors. It’s considered a secret.
mottsapplesauce said
Forgive me Whitecoat if I go off on a tangent but, this really struck a chord with me. My husband’s been an incomplete quad since 1982 (Fx C7). Once he no longer needed PT/OT rehab, he came to a point in his life to either get busy livin’ or get busy dyin’. He was on disability until he regained his productive status in society by going back to work & finishing college, all from a wheelchair. He’ll be fifty-one this year, works full time, drives his own van, & requires little assistance. He’s been through more healthcare ups & downs than I care to mention. He has always faced adversity tenaciously, instead of giving in to it. He’s had his share of bad days & will always have ongoing health issues, regardless of how well he takes care of himself. He works for a cell-phone company in financial services (glorified collector he calls it). What really frosts his cookies, is when a customer is hotlined from overdue balances & they say, “I can’t pay my bill because I’m handicapped/disabled”, yet they continue to use their phone beyond the allotted free minutes. Too many of them treat it like a landline. So he bites his tongue & attempts to help them upgrade their rate plan, to avoid future costlier bills. Only a few are receptive & thankful for his help. The rest call him every name in the book & then some because they feel they deserve a credit on their bill. He’s come to understand that it’s a mentality type more than a physical type, that tends to demand something for nothing.
nzou said
I’d say about 75% of the people I see who tell me they’re on disability can’t give me a straight answer or literally say they don’t know why. I run into many young people who aspire to be a disabled person. I saw one 20-something this past year who decided he’d be better off financially by being disabled. He said he couldn’t beat the benefits of the $900 monthly disability check, the food stamps and the free healthcare. He was newly married and I asked him how he’d provide for any children he might have in the future. He said he hadn’t thought that far ahead, but you and I know who will subsidize his children – us.
What irks me just as much as the laziness of the many people who maliciously apply for disability is the fact that lawyers get a cut of disability benefits. The lawyers are actually incentivized to help people take advantage of the system. Are all lawyers bad? No, but we produce far too many of them and they’ve gotta make a living, right?
Frank Drackman said
Best one I ever got was a patient who wanted their Handicapped Parking form signed, along with an Insurance Physical form stating they had no chronic medical conditions.
rogue medic said
Perhaps not having chronic medical conditions is coming to be viewed as a disability, by some. No entitlement? You’re selling yourself short. Think of all of the government benefits that you are passing up. If you don’t use them, they are all going to waste. Just a touch of sarcasm.
silverstar98121 said
I am disabled. I worked very hard as a nurse for 35 years until my knees gave out. I can’t get my knees replaced because of my fibromyalgia. Or so my surgeon says. In addition, I have a 30 year history of chronic depression, and need 3 anti-depressants to get out of bed. Yeah, I can answer phones and do data entry, but do you know anybody who is going to hire a 58 year old to do that? Especially since a lot of those jobs went to India.
It took me four years of living on $339/mo and food stamps to prove I was disabled. If I could have found a job, do you think I would have bothered? Give me a break. Yeah, they give you a “Ticket to Work” as soon as you win disability, but after four years of this crap, am I really going to risk trying to get a job, and maybe lose it? I hate it when I hear all this crap about people who get on disability for no reason. It’s a long slog even for people who “deserve” it. People who think it is easy don’t know anything about the system. Personally, if you made it so that I could work, and maintain my Medicare and supplement my income, I would work. But the way it is, they cut you off if you make more than $900 a month. Know anybody that can live on that? Ya’ll can kiss my grits.
medrecgal said
Could part of the problem here be that as a nation we’re so quick to turn every ache, pain, or unusually strong emotion into a diagnosis? I’m not suggesting there aren’t legitimate reasons out there for receiving disability, but in my own experience it seems like there are far too many people out there not working because of various psychiatric diagnoses, often combined with nebulous, poorly defined “syndromes” like fibromyalgia. (Or else they’ve got something like chronic back pain or an old knee injury from 1986.)
I’m not an outsider passing unwarranted judgement, either; I have a couple of formally diagnosed cognitive disabilities that have made the attempt to get an appropriate education and a decent full-time job a huge headache that took seemingly forever to accomplish. The difference, as I see it, between me and these other people WhiteCoat describes is that I don’t try to hide behind my diagnoses or use them as an excuse to permanently suck other people’s money off the system. Temporary help I have no problem with, but people who seem permanently unable to do ANYTHING just boggle my mind. (And I’m not talking about people who formerly held down some kind of job and got injured or had some sort of catastrophic illness that left them unable to return to work.) Even when I was still trying to figure out the process of getting an education, I still held down a part-time job…
As for the last commenter above: I will be the first to admit the system is seriously broken, both in the way it punishes people for obtaining more than a prescribed amount of income and in the way it seems to discourage any attempt to get off it. I’m sure there are a lot of people out there who don’t relish needing “the system” (I know I have never relished it…). Ageism (which is really what you’re describing with your comment about being 58) doesn’t help, either. It’s the twenty-somethings or thirty-somethings who say they’ve got some nebulous syndrome or too many psych issues (or even better, BOTH!) that get my goat. (And I know a few of these types personally!) Maybe the good ranting doc has some idea about why this situation seems so common? Am I totally warped here or does my observation have some legitimacy to it?
medrecgal said
Somehow that comment above got an inadvertent smiley stuck in after publishing…that line should read
“(which is what you’re really describing with your comment about being 58)”.
silverstar98121 said
Strange how someone with formally diagnosed cognitive problems can say that someone else’s problem is a nebulous syndrome. Only those people who have never woken up with the pain, never fought the IBS that goes with it, never punched their way through the fibro-fog would call it a nebulous syndrome.
And it’s not your money, it’s my money I paid into the system for 40 years. Just like if I’d invested it, except I can’t lose it in the stock market.
cathy said
I keep trying to figure out how some of these people get on it? It is not just that you go apply and someone calls you up and says “OK we believe you so now we will send you a check every month”. I had worked over 35 years at a job that required standing and walking for many hrs each day. I also had/have long term OA and RA, had already had total joint replacements, have since had 3 level fusion in my lower spine for the severity of arthritis, and other medical issues as well and getting my disability was a nightmare that took almost 2 years.
Seems odd that people can get it that don’t really need it.
silverstar98121 said
I live in a whole building dedicated to disabled people. Most of them live on SSI or SSDI. Some of them don’t “look” disabled when you see them on the street. But I see them when they’re off their meds, or having an angina attack. It’s not only visible disabilities that will get you on SSDI. Isn’t it written somewhere that we should judge not lest we be judged?
medrecgal said
I’m not suggesting here that there aren’t people out there with chronic problems not plainly obvious who need disability assistance. I’m suggesting that in SOME cases it seems that there are people who use nebulous (and by that I mean poorly defined and not fully explained) problems or diagnoses to get this kind of help. You can’t tell me there aren’t such people out there, because I know some personally.
I was not, as I said, talking about those with chronic conditions that are clearly medical problems but may not be plainly obvious to the next person. Angina, for instance, is of course not plainly obvious most of the time. But I certainly could see where an individual with this problem could have trouble maintaining a job and would thus need assistance. And I’m not talking about the “off their meds” sorts either (perhaps a person with bipolar or depression or schizophrenia)…they are clearly prone to problems that could very well keep them from holding down a permanent job. (I’ve known a few of them as well.)
Perhaps it looks like “judgment” because I already know what it’s like from the other side…and find it hard to believe some of the things I’ve heard people trying to get government assistance for. (I’ve heard it from people who work in that government… it’s not something I just pulled out of a certain orifice.)
I was commenting not on an individual situation, but rather problems with the way our culture has this tendency to view every variation or possible issue as a “disease” or “condition”. That predisposes some people to think they need assistance for everything, and that’s what I was commenting on…not people with legitimate disabilities, of whom I also know many.
Gabriel... said
“The powers that be have created an economic incentive for everyone to become disabled.”
“I keep trying to figure out how some of these people get on it?”
“You can’t tell me there aren’t such people out there, because I know some personally.”
“[I] find it hard to believe some of the things I’ve heard people trying to get government assistance for.”
“That predisposes some people to think they need assistance for everything…”
“…in SOME cases…”
I think we need a definition of “SOME”. Anyone care to come up with a percentage of people on disability who cheat? 40%? 35%? 6%? How about we substitute “in SOME cases” with “in a vast minority of overall cases”? It seems to me it means pretty much the same thing, but one seems like an accusation… doesn’t it?
So far this discussion has involved a lot of educated people blowing off steam and using half-truths and urban legends to try and make a point that might even be, at its base, valid. That point being “a vast minority” of people using the disability system actually cheat the disability system.
So how about some REAL numbers? According to a report published on August 3, 2008, by the AARP:
* 762,000 Americans sit in an unprecedented backlog of disability claims. …and if the claim denied the appeal takes [national average], 512 days.
* About 65 percent of people who first apply for Social Security disability are turned down, and most of those who ask to have their cases reconsidered are denied again. Along the way, 1.1 million claimants give up each year. The majority who fight on — about 500,000 — eventually win their claims.
* But to do so, they have to request an appeals hearing before one of Social Security’s administrative law judges, who have the power to award benefits. This sends applicants into a complicated, often crushing world of lawyers and medical experts.
* More than 7 million Americans now collect benefits from Social Security’s disability insurance program, drawing an average monthly check of $1,004, according to a recent sampling by the [AARP].
* To qualify for benefits, you must prove your medical problems prevent you from any “substantial gainful activity” (defined as an average income of $940 a month) and must show your disability has or will keep you out of work for 12 months or more.
None of that seems easy to me, or particularly desirable.
Here’s something from “60 Minutes” (Nov. 17, 2002) that might add something to the discussion:
“UnumProvident is the largest disability insurance company by far, providing disability insurance to 17 million Americans. Gina Hartley worked for five years as a claims handler in the UnumProvident’s headquarters.”
Ed Bradley: “You knew of people who were really disabled and their claims were terminated because in terminating those claims UnumProvident would save money.”
Gina Hartley: “Oh yes, oh yes.”
“In 2004, [UnumProvident] ended an investigation of complaints about claims handling with an agreement to reconsider about 200,000 claims…” (The San Diego Union-Tribune)
Seems to me that “the powers that be” in this case were doing all they could to keep disabled people from their money.
August 7 roundup said
[...] More thoughts about “going on disability” [White Coat Rants] [...]
Purveyor of Iniquities › Links for August 8th said
[...] Why Is It … ? « WhiteCoat Rants“No, I don’t work anymore. I’m on disability.” He appeared normal to me, so I said “Really. Why?” “I have a seizure disorder.” I nodded my head and finished his discharge papers. Then I went back and asked him if there was someone with him to drive him home. “No – I’m OK to drive. I haven’t had a seizure in a few years.”(ada disability ) This was written by Andrew Grossman. Posted on Friday, August 8, 2008, at 2:13 pm. Filed under Uncategorized. Bookmark the permalink. Follow comments here with the RSS feed. Post a comment or leave a trackback. [...]