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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 25
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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 26
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