Wednesday, March 11, 2009

Hard Labor

This is prompted by a post by one of my favorite interlocutors. A large part what is lovingly called "the art of medicine" is really just common sense, which has as little to do with art as with medicine (unless it can be said to be the art of life). Doctors are given surprising authority over what should be common-sensical matters, and a good is example is the dreaded "When should I go back to work?" question.

I don't recall a medical school course on determining when people can return to work, although that may have been more helpful (for those without common sense at least) than whatever impractical biochemistry we were memorizing at the time. I'm not talking about the toxic Permanent Disability matter, but the routine but frequent need for folks to have a doctor-sponsored mental health day (or week, or month).

Usually this comes up, of course, when someone is in crisis, and when a patient asks the return-to-work question, my unspoken mental response tends to be a shoulders-shrugging, slightly smart-alecky, "Beats me." That is, he knows the particular cognitive, interpersonal, or physical demands of his work, and the likelihood that he is up to them in his current state, far better than I do. But in reality, he has usually already decided how much time off would be helpful and appropriate, and he is seeking an officially medical imprimatur. The amusing thing is that employers would treat my handwritten note as some kind of solemn injunction. The enforced rest cure, as it were.

But at least I am there when common sense fails, as quality assurance I suppose. Usually the week or so that someone wants off is quite reasonable, but occasionally the inches threaten to extend to miles with respect to someone's hated job. Or more rarely, the workaholic or the dutiful will overlook the obvious need for a break. I am a kind of offsite referee for the peculiar dance of the workplace.

All this falls under the nebulous domain of clinical judgment, at least, when the magic wand and crystal ball are out of order. The wisdom thing. As the systemic and cultural authority of doctors wanes, hedged in by managed care, insufficiently awed patients, etc., one would be inhuman not to relish at least a few quaint areas in which we wield near-absolute power. Thou shalt not work...for three days, or the lightning bolts will fly.

1 comment:

Anonymous said...

Deadlines usually relieve procrastination. Prognoses for terminally ill patients usually relieve them of life within the specified time. Maybe definitive timeframes for convalescence aren't such a bad idea.

Placebos are a good thing in the right minds. It's all in the delivery. Fire with fire, irrational with irrationale...