Workers’ Injuries

Sun (Auckland), Volume IV, Issue 1080, 18 September 1930, Page 8

Workers’ Injuries

Medical Board Suggested

TJIE establishment of a Medical Board to act in the cases of examinations and claims under the Workers’ Compensation Act ivas discussed and favoured by several speakers at a recent meeting of the Auckland division of the British Medical Association. Attention was drawn to the present-day “spectacle of three or four medical men appearing in the Arbitration Court on different sides and testifying in terms which, to the layman, convey seriously divergent views.”

Because o£ the lack of opportunity for consultation and the consequent wide discrepancy often apparent in evidence tendered, the medical profession was becoming adversely criticised, said Dr. Kenneth MacCormick, in opening the discussion. The trouble arose mainly from the fact that medical men were not acting in -their proper capacity as referees, but as advocates for one side or other. Dr. E. B. Gunson said that one of the chief difficulties in arriving at a satisfactory assessment of cases at a later date was the absence of a written record made at the time of the original injury. “It is impossible,” he said, “to testify accurately from memory as to the physical signs when an interval of months or even weeks has stlapsed from the date of the medical examination.

“Complete laboratory and X-ray investigation may be necessary before a definite diagnosis can be reached, and should be insisted upon in the interests of ail parties. Intuitive diagnosis can have no place in the consideration of compensation cases.” In stressing the importance of the medical examiner in the machinery of the Workers’ Compensation Act, Dr. V. S. Macky said the examiner must always deal fairly and impartially with the injured because, even if he be acting for the company, he must see that tho man gets his dues, while at the same time he must protect the company from being exploited by the malingerer and the exaggerator. PATIENT’S RIGHTS The examination of the injured person had to be carried out as if he were a private patient. In medicine, a man was a patient until proved a malingerer, and was entitled to a courteous and painstaking examination. "The real malingerer is not hard to detect,” said Dr. Macky. “Early in his examination the examiner gets the idea that all is not on the square. The motive of the malingerer is to deceive and he usually overacts his part. “In a lower limb case, when walking into the room he will have a gross limp, and there is the old saying that the malingerer is more lame than the paralysed, sees less than the blind, and hears less than the deaf. “If an upper arm case you will find, under indirect observation, in the act of undressing he will use the joint freely, while later when the direct examination is taking place you find that ho resists all attempts at movement, and the voluntary attempt is a very feeble effort. “Pain is the malingerer’s common complaint—it is of the vague type, for

he is afraid to localise it for fear that he is wrong in direction —it is constant and severe and not influenced by treatment. “By indirect test we are usually able to demonstrate that the pain is not real, for pain is the outward expression of a pathological condition within, has a definite localisation, and is in proportion to the severity of the lesion.” EFFICIENT, EXPEDITIOUS After referring to the unavoidable delays because cases are heard, Dr. Macky said he thought the establishment of a medical board with a legal head would be an effective part of the machinery of the Act. “This board would, in my opinion, be not only an efficient and expeditious way of dealing with cases, but a cheaper method of disposing of such cases both to the man and to the company. Further, the rapid settlement of the case would avoid anxiety, neurosis, or litigation neurasthenia.” Dr. Kenneth Mackenzie said: “There is a note of warning to be struck if consultations are held that we do not appear there as bargainers on behalf of plaintiff or defendant, with a tendency which I have seen for one party to put too high and the other too low an estimate on the damage with the idea that a compromise will be reached at about halfway. That is an abuse.” Dr. Mackenzie said he believed that if statistics of the recovery time of injured footballers and farmers tvere compared with those of workers, a decided difference would be found — a difference which he would not for a moment attribute to malingering, a comparatively rare phenomenon, but to other factors which were more or less gathered under the name of litigation neurosis. Mr. H. P. Richmond, speaking as a member of the legal profession, said: “Candour compels one to admit that too often partisan medical evidence is given. “It is necessary for the honour and dignity of your profession that no element of heat or even of sympathy should colour the clear fountain of scientific fact and scientific opinion. “There is a very common vanity in us all that makes it difficult to retract from an opinion once expressed. . . . Mental honesty would lead to many frank admissions under crossexamination where now such crossexamination is merely an ineffective battle of words.” The speaker added that it had occurred to him that there might be a permanent medical board in each considerable centre before which injured workers could be examined without delay.