Tuesday, March 28, 2023

Insults and Indignity

It is not common for the nuance of workers' compensation to make the national headlines. And, arguably, Best Life is perhaps not the national news. Recently, the MSN news feed picked up a Best Life article concerning a man in British Columbia and comments a physician made that were documented "in his official workman's compensation file." That is not a typographical error. The publication used this antiquated and genderist term. I was unable to find references to "workmans" on the British Columbia website. Let's all get with the modern world  and use "workers'?"

The headline caught my eye as it referenced medical records. However, it is likely that references there to "uneducated massive redneck" and "playing the system" caught my attention. The author refers to these as not "mildly negative." The origin of this worker's challenges is somewhat typical. There was an injury at work, a claim filed for compensation, various medical care, and ongoing physical complaints and symptoms. 

The injured worker reviewed his "workman's comp file" (sic) and noted various allegations and observations. There were comments specific to medical evaluation, but also generalities regarding where the worker lived and his "lowlife style," as well as conjecture and dispersions (that may have been "low life," but it is less than clear). The worker was troubled by the comments generally, but also noted that "the doctor was really nice, to my face anyway." The worker contacted a caseworker at WorkSafeBC and complained. Notably, the British Columbia workers' compensation process is monopolistic (the government is effectively also the insurance company). 

The caseworker documented the workers' reactions and concerns with a complaint. The company through which the physician's care was delivered (it is not clear if the physician is an employee of that entity or a contractor affiliated with it) has expressed disappointment. Its spokesperson noted that the company has a "duty to be respectful and compassionate to the individuals we serve." Well, we could say that about any or all of us. This is a reminder that everyone in the workers' compensation community is a person, not a number. And that professionalism is virtuous and desirable. 

The worker's spouse focused on the references to where they live. She concluded, "I absolutely think this was a general discrimination against people who come from small towns." There are feelings expressed, of "upset," and descriptions of crying. The spouse concluded that while the workers' mental health was impacted by "not being able to work," the medical record statements were further detrimental. She characterized the experience as not "helping." The worker noted that despite the publicity and complaint, he has not heard from the physician. He notes that "a major apology would be nice." Is that not always the case when we are hurt by someone?

The coverage raises various thoughts. Some general, and others about the workers' compensation process and system. In a general sense, there is no reason to engage in generalities or conjecture as to people. That said, there is a myriad of potentials upon which humans may be biased. MasterClass notes "All of us, no matter our education, intellectual commitment, or good intentions, are susceptible to biases." That reference is specific to 14 particular biases. Are you biased? Is it worthwhile to ask ourselves that question?

The MasterClass article is a reasonable overview but is by no means exhaustive. Whether it is appearance, hometown, living arrangement, or any other observable characteristic, it is practical that bias or prejudice might exist with some. The challenge is heightened by the chance that this is as likely to be conscious or unconscious. How often do we make human judgments as to people, circumstances, and outcomes based upon underlying layers of preconception and assumption? You know, like if they have an "A" license plate on the front of their car? (Before you are offended, I did not say what that would make you conclude, good or poor). As there is this potential of unconscious bias, is it even possible for us to recognize how often it occurs in our thoughts? How often do you think about it?

Another general concern is that records in workers' compensation proceedings may well be public records. That they contain untoward or uncomplimentary descriptions is troubling in this regard. That said, there is often news and views that we might each dislike, reject, or regret. So, that is a reality in life. But, in a broader sense, this news story is a reminder that such documents are likely not a place in which unnecessary, ancillary, and superfluous observations need to be memorialized. If something negative is necessary - "the results were inconclusive," "the test does not support the complaints," "the radiology disproves the described mechanics" - then it is unavoidable. But let's keep those to the relevant and probative, not the demeaning and prejudiced. 

In a more specific sense, the article here highlights serious concerns. There is perhaps some merit in the spouse's focus upon geographic prejudice and potential discrimination. There is some "small town" bias perceived, and perhaps rightly so. But, there is also some background bias in the label of "redneck." There is much we might say about that term. In time, it is possible that merely the use of that term may be impermissible and shunned. As this post is read in years to come, my mere repeating of it may be perceived and attacked. Never mind that it is in the article headline, some may blame me for its use. 

See Humor and Failure (August 2022); Funny or Offensive (October 2022); 

Famous comedian Jeff Foxworthy has made a fortune from ridiculing "rednecks." His approach was self-deprecating. He reportedly noted that "I always felt like you couldn't talk about rednecks unless you are one, and I are one." There is humor there, and many laughed as he recounted his observations about the manner in which real people live. There are a great many urbanites in this world, but a fair few still live in rural environments. And, the pejorative "redneck" might be thrown at any of them.  Regardless of where one lives, that term is insulting and perhaps worse. If you would not use other pejoratives, consider avoiding this one also. 

Is it any worse than occupational classifications? There is persistent humor heaped on various professions, trades, and vocations. Are those any less than derogatory stereotypes? Though they may be humorous in some context, are they simply illustrations of bias and preconception? Is there anything other than implied superiority that renders these observations somehow humorous? The role one has in our society and economy does not alter that she or he is or is not injured, restricted in terms of duty, or suffering an impairment. 

Most specific in the context of this example is the concerns of subterfuge, exposition, and inquiry. Are we better off when people openly express their bias? As offensive as the medical record notes are, is it better that such is illustrated, documented, and open? Without such inane and insipid statements, might we be left to wonder about the potential for bias impacting a physician's conclusions? After all, this physician was "nice" to the workers' face. Until the statements are read, "who knew?" They say "it is better to remain silent and be thought a fool than to speak and remove all doubt." Are we better off knowing?

That is, is the exposition better than the wondering. Perhaps we are better off in society if people wear their hearts on their sleeves a bit. Knowing people can be difficult. If they are willing to tell you upfront who and what they are, is that not a benefit? 

But, to the inquiry itself. Perhaps the most important lesson in this instance is the injured person that took time to review his own file. Even without the absurd comments located in this instance, what might be gleaned from such a review? What if the accident injured the right ankle and the medical records in the file all say "left?" Or, worse, they all say "low back." The review is of value. This is good practice for confirmation, but also perhaps to prompt more questions and discussion.

There is value in expressing your symptoms and complaints when seeking medical care. Likewise, there is strength to be gained from others accurately hearing and perceiving your expressions. There is communication necessary in the art of medicine. That, to be effective, will include accurate transmission and receipt. Whether that has or has not occurred may well be apparent in those records. How many patients have ever taken the time to review their own records as the protagonist from BC did in this instance?

It is troublesome that this instance occurred. It is positive that it made the news. There are lessons and reminders here that are poignant and pertinent.