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OCR for page 25
CONVALESCENCE, DISABILITY, AND REHABILITATION
At a meeting of a local Committee on Trauma of the American
College of Surgeons, a theoretical problem was presented to
approximately 50 distinguished surgeons as to when a young man
should resume heavy labor following specific injury. The estimates
of duration of disability ranged from 2 weeks to a year, with
little concentration of the estimates in between. There is little
scientific basis on which to predict or measure convalescence or
disability. Rehabilitation should begin immediately after injury and
its goals should be to prevent disability or shorten its duration and
degree and to return the patient to a useful economic status.
Rehabilitation should not be reserved for those with established
permanent disabilities.
RECOMMENDATIONS
1. Development of additional studies on the quantitation of degrees of
disability and the stages of convalescence at which return to productive
work is indicated.
2. Development of studies on rehabilitation with emphasis on measures
to be initiated in the earliest phases of treatment.
MEDICOLEGAL PROBLEMS
The courtroom sequelae of accidents are often, perhaps generally,
dealt with in a manner below the general standards of the medical
and legal professions. The courts for settlements of disability
claims in some areas are provided with inadequate or inexpert
evidence, and judgment may well resect response to social,
emotional, or political pressures, rather than to sound medical
testimony. In this respect both lawyers and physicians for the
claimants and for the defending insurance companies too often
produce prejudiced medical testimony, diametrically and predict-
ably contradictory. "Expert medical testimony" under these cir-
cumstances has commonly lacked clinical expertise. A system has
been adopted by the judiciary in a number of localities to provide
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impartial evaluation of disability by a panel of physicians who are
expert in their given fields and paid either by the court or jointly
by the parties involved. This mechanism has proved to be of great
value, and should be more universally employed. It is imperative
that the physician's role be uninfluenced by socioeconomic
pressures.
In the final analysis, compensation for disability is a drain on
every citizen through federal taxation, withholdings from earnings,
and the increasing upward spiral of premiums on disability insur-
ance. All these costs could be reduced if the demonstrated fairness
and objectivity in categorizing degrees of disability employed by
the Armed Forces and the Veterans Administration were applied
by the medical profession and the courts to persons disabled by
accidental injury or disease. In the military services, processing be-
gins at the time a member incurs an injury or disease that may be
temporarily or permanently disabling. Findings are referred by a
medical committee to a physical evaluation board and reviewed at
the highest levels, with the benefit of counsel at all stages, providing
an objective determination of degrees of disability to serve as a
basis for compensation. Society concurs in the fairness of this
system and the care with which the Veterans Administration and
the Armed Forces protect the rights of the nearly 2,000,000 per-
sons who receive service-connected disability compensation among
the 21,800,000 veterans of military service. The same objectivity
and fairness can be applied to the rest of the population through
optimal medical care to prevent disability, a hospital trauma com-
mittee to judge disability, and impartial medical panels to serve
the courts. Systems for rapid and uniform processing and compen-
sation of the injured with minimal recourse to the courts should
be applied nationally.
Forensic medicine constitutes a medical specialty of high order
and only when a sufficient number of specialized physicians are
available to carry out this work will important information, now
needed, become available. Unfortunately, most coroners in this
country are political appointees, mostly laymen, frequently funeral
directors; but this situation is being gradually corrected by estab-
lishment of medical examiner systems in several cities, some
counties, and a few states. Progress in this area must: be accom-
panied by the training of more pathologists in forensic medicine.
With the expansion of the role of the medical examiner, imple-
mentation of a uniform code for reporting accidents and accidental
deaths, and mandatory autopsy of fatal cases, to include tests for
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Representative terms from entire chapter:
armed forces
