During the course of the last week, I stumbled across three separate items that tend to ignite certain passions. In one case, I had to clarify a certain legal position which led me to discuss my three least favorite items, the lack of use of current evidence-based medicine, liberal construction and presumption.
The Widening Gap: Evidence-Based Medicine in a Rapidly Changing World
When I was in my clinical training, it was offered that the half-life of the clinical education was approximately 15 years. What this meant was that everything we had learned in our training, half of that education would be outdated or replaced with new knowledge within 15 years. More recent studies suggest that the half-life of medical knowledge is now reduced to approximately 18-24 months. Moreover, with all of the technical advances and AI changes coming down the pike, it is projected that the half-life of a medical education will be approximately “73 days.”
What this means is that the volume of information is so vast and complex, it is well beyond human capabilities to obtain and retain all of that information. What does this mean in a workers compensation environment? The use of all available tools will be needed so that the most appropriate treatment is delivered to all injured workers. Each participant in the workers compensation ecosystem needs to have ready access to all of that information.
Another key component in dealing with workers compensation care is the application of evidence-based medicine. In some jurisdictions, the phrase evidence-based medicine has been incorporated into the statute. As an example, in Texas Section 18-a defined evidence-based medicine as the current best quality scientific and medical evidence formulated from credible scientific studies, including peer-reviewed medical literature and other current scientifically based texts. This is the standard that all those involved in the adjudication process must adhere. As technology advances, this is an educational bar that is ever increasing in its elevation, in order to handle.
Liberal Construction and Presumptions: Navigating Legal Frameworks Amidst Medical Evolution
Another concept commonly used in the Worker’s Compensation adjudication protocol, which does not get much publicity, is liberal construction. This is a method for interpreting the laws and documents that focuses on the intent of the statute as opposed to literal wording. Given that workers’ compensation was created to protect the employee and is the sole remedy, there is an inclination to bending towards the injured employee in the determination to be made. In short, liberal construction aims to apply the spirit of the statute, if not the actual written word.
The 73-Day Horizon: How the Shrinking Half-Life of Medical Knowledge Impacts Workers’ Comp
One last item is the concept of presumption, hopefully rebuttable presumption. Presumption aims to facilitate decision-making processes, negating the need to directly prove a fact. Proving some facts can be difficult, time-consuming, if not impossible. The only avenue towards achieving a reasonable goal is showing a rebuttable position. As noted above, the half-life of medical education is anywhere between 3 months and 2 years. Given what it takes to mitigate a statute, one needs to have all of the current clinical data relative to that particular disease process so that the most equitable decision can be reached as opposed to a default position. One does understand that these presumptions were created to advance a social policy. At the time of statutory enactment, the reality may be at one end of the spectrum. However, with clinical data, the current reality is far different. Again, having all appropriate current clinical information is paramount in the adjudication process. Understanding that presumption is a “legal shortcut”, and probably more convenient, such a presumption is not an absolute and there may be significant current clinical/medial evidence to the contrary. This is the evidence-based medicine clinical standard that should be applied when facing these presumed conditions.
Conclusion
In summary, these are three items we as participants in the workers’ compensation system need to be aware of and prepared to employ all tools to meet the challenge.
By understanding the rapid pace of medical advancements and critically evaluating the application of evidence-based medicine alongside legal concepts like liberal construction and presumption, all stakeholders in the workers’ compensation system can strive for more accurate and equitable outcomes for injured workers. Contact us today to find out how we can help!