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Heath: Defining Health, Well-Being and Functional Capacity

It is understood that we need to be healthy to be able to work. So what does being healthy mean?

I first look to the trusty dictionaries as to how health is defined.

Dorland's Illustrated Medical Dictionary defines health as "a state of optimal physical, mental, and social well-being, and not merely the absence of disease and infirmity".

Next I turn to Wikipedia, which speaks to health as the general condition of a person's mind and body, usually meaning to be free from illness, injury or pain (as in "good health" or "healthy").[1] The World Health Organization (WHO) defined health in its broader sense in 1946 as "a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity."[2][3] Although this definition has been subject to controversy, in particular as lacking operational value and because of the problem created by use of the word "complete," it remains the most enduring.[4][5] Other definitions have been proposed, among which a recent definition that correlates health and personal satisfaction.[6][7] Classification systems such as the WHO Family of International Classifications, including the International Classification of Funding, Disability and Health (ICF) and the International Classification of Diseases (ICD), are commonly used to define and measure the components of health.

Patient / case scenario

So what happens in the case of John Doe? He is 45 years old and the primarily bread winner for his family of 3 young children, and his wife Sally is currently not working as their youngest child is 3 months of age. John was in a motor vehicle accident where he injured his back. He is not back at work where he works at the pork processing plant. He sees his family physician regularly, attends physiotherapy 3 times per week and does his daily home exercises. However he still has problems with standing and walking for any length of time, and lifting any significant amount of weight. The physiotherapist and physician try to reassure John that "it just takes time", however the case manager of the insurance company keeps asking him when he is going to be back at work.

Worry is introduced

John is getting worried because the case manager tells him that he should have been healed by now. He saw what happened to his neighbour Sam when he had a work injury last year. The insurance company "cut him off" when they thought he should have been better, yet Sam is still off work and seems to be doing worse.

John has not been sleeping well lately and finds it harder and harder to motivate himself to help out around the house. He keeps thinking that he will end up like Sam, unemployed with no hope of finding a job because "who is going to hire someone with a bad back who can't do their job?"

John also kept thinking about the CT scan and the specialist appointment, that this would be the answer. But the doctor told John that they could not find anything wrong with his back. John now worries even more "people don't believe him that he really has an injury, the doctors just can't find it".

Functional Capacity Evaluation

John Doe is referred by the case manager for a Functional Capacity Evaluation (FCE), where the question is can John go back to work at the pork processing plant. The medical documents that accompany the referral record his slow progress with physiotherapy, and reports of ongoing pain.

So now the Occupational Therapist (OT), who is the Expert in enabling occupation, is going to determine John's functional capacity and return to work ability.

I would think that these are pretty big shoes to fill! Yes, all of the typical testing will be completed, range of motion, strength testing, lifting, carrying, pushing/pulling, standing, walking, pain questionnaires. John keeps telling the OT during the FCE that his pain is getting worse, and that he does not want to overdo it, as he will then suffer for a few days. The OT says "yes I understand but you need to try as hard as you can, it is very important that the insurance company sees that you gave your full effort".

Fear is introduced

John also keeps thinking about the case manager who keeps telling him that it is his responsibility to fully participate in rehabilitation. His neighbour Sam was told by his case manager that he was not trying hard enough and now he has no money coming in.  But are John's perceptions accurate?  Or are his perceptions skewed and now they are effecting his ability to fully participate in rehabilitation?

So when I look at John Doe's scenario who sustained a physical injury and regarding the question of his functional capacity and return to work ability, what about that definition of health, where does this fit into the scenario? What about the "optimal physical, mental, and social well-being, and not merely the absence of disease and infirmity"? As the expert in enabling occupation do we address John's worries and concerns so that he can participate fully in the FCE or do we ignore them?

Continued... Functional Capacity Evaluation – a moral dimension

Thursday, May 01, 2014
Posted by Lorraine Mischuk at 3:17 PM 0 | Comments

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