Where Disability Comes From

I have a short list of the 3 things I dislike the most about doctoring:

1. Narcotic pain med management
2. Reviewing my dictations before signing them
3. Filling out disability paperwork

I had a bit of an epiphany regarding disability a few months ago. It is (in my opinion) an unfortunate part of our jobs that we certify disability. I prefer the forms where I just get to write what I see/know from a medical standpoint, and someone else decides whether that means they can hold a job, but often times I'm the one making the call, which is always with a large degree of uncertainty.

My epiphany came when a women came in for an annual examination. She is in her late 30s and is in a wheelchair due to a genetic condition called spinal muscular atrophy. The important point is that she has very limited use of all her extremities. She also was born without an essential enzyme to help with everyday energy production, and certain amino acids will make her incredibly sick. It's called phenylketonuria, and you can check out a warning to her and other with her disease in the small print on the back of your Diet Coke. All this, and she's just here for an annual exam. No worries. She has a husband and kids and runs a small business just north of the Ohio state line.

Later that day (maybe the next day), I saw a woman about her same age, sitting in the room with her daughters, neck rigid with debilitating pain that has gone on for over 4 years. I (and numerous other specialists) have tried and tried to find anything wrong with her bones, muscles, nerves, or any other part of her body, and all of it appears totally normal. No medicine helps. No therapy helps. I wish I could say this case was unique. She came in that day to get forms for disability filled out, so that she could get some cash assistance. So I filled them out. "What physical findings support this disability?" Well, none. "What tests and exams support this?" Also, none. "What is her diagnosis?" Just 'neck pain'. "Can she hold any job at all?" Now, why did they have to go and ask me that? Taking it all together, I would have to say that no, she can't. I don't know why, but I know from interacting with her that it's not going to work.

So, what makes for disability? I'm convinced that emotional well-being is really where it originates. The first lady taught me that almost no physical disability can't be overcome is the rest of one's person is well-functioning. And the second woman (and dozens like her) just reinforces that nothing may be physically wrong, but the emotional/social/spiritual health of a person is easily enough to push them into a state where even a basic job will probably not be doable.

The next step would be then to work more towards this model of holistic health for people. Unfortunately, I don't really think we're all too good at that. Not in medicine. Most of that health has to come from elsewhere.