Tag Archives: occupational healthcare

To Report or Not to Report – That is the Question

This is a question supervisors, bosses, and HR specialists ask themselves constantly, albeit quietly.

Everyone wants zero injuries and companies have been known to insist on watchful waiting before committing to medical care and a reportable injury. This is a risky game but I offer some guidelines that should help you avoid some of the deepest pitfalls.

Does this “injury” need medical care?

I will start with the disclaimer that the safest thing to do is have any injury evaluated. The injured employee will do better and you and your company will stay out of trouble. But, if I were a supervisor, I would want some help in trying to sort the serious from the nonsense.

In looking at a possible injury, the first thing an employer naturally considers is who the employee is. They are thinking of his HR file: attitude, reliability, productivity, attendance. Essentially, are they a great employee, or a marginal one? That approach may guide you in determining whether the employee will be here next year, or will get a promotion, but is the wrong place to start for work-related injuries as it has nothing to do with the outcome from a specific event.

So put down the HR file and start somewhere else.

A good place to start is with the “mechanism of injury.” That is a term for “what happened” – the employee got hit with a hammer, fell down, or lifted something heavy. Would you expect a serious injury from this particular circumstance? How much force is involved? For example: If someone falls off the loading dock onto concrete, and doesn’t land gracefully on his or her feet, a fracture is more than possible, even expected. The opposite circumstance is someone hitting his elbow against a doorframe while walking through an opening. That would not be expected to produce a major elbow injury.

So consider the force put upon the body at the time of injury. Rule 1: Big force causes big injuries. That tells you to be very concerned about even an apparently minor injury if there was major force involved. An employee falls off the roof — have them checked out, even if he attempts to brush it off.

Injuries come from outside forces acting on the outside of the body. Since the body is conveniently covered with flesh and blood, there is often physical evidence of this injury. Especially in an extremity, there will often be swelling, a black-and-blue skin coloring, tenderness and sometimes “it just doesn’t look right” – because there is a minor deformity. If it doesn’t look right, beware.

All of these suggest more injury rather than less. So the second rule is if it looks injured, get it checked out sooner. The third rule is to minimize downside risk. In medicine downside risk is a tragically bad outcome, disability, death, medical complications – of course, all very bad stuff.

Doctors are trained to instantly think the worst, and go about proving to ourselves it isn’t that bad. That approach avoids missing something important that will cause great grief if missed.

In essence, you ask yourself: “What is the chance of this becoming a big problem if it doesn’t get treatment quickly?” That is, admittedly, difficult to do without a lot of medical background, but we can suggest a few scenarios.

A head injury with even brief loss of consciousness or appearing dazed is concerning. This is a brain injury. Brain injuries are always serious, because they can turn out very badly very quickly. This employee needs to be evaluated even if he or she claims to be fine. The downside risk is too great not to aggressively look for trouble.

Broken bones can have really lousy outcomes if not taken care of. Quite often the injured employee can tell you they have a broken bone. They hear or feel the bone break. Believe them and get them checked out promptly. Foreign bodies in eyes are a very common industrial injury. The employee will tell you they have something in their eye. They are almost always right. If a foreign body is not removed it will become harder and harder to remove and put your eye and vision at risk. It’s always worth trying to wash it out at work, and if that solves the problem, no worries, but don’t waste more than 10 minutes trying to wash it out. If you can’t get it out right away, it needs to be removed by a doctor.

All employers attempt to separate the truly injured from the minor stuff.

A little common sense when combined with some thought about mechanism of injury, signs of injury, and downside risk will go a long way toward helping you make safe decisions. Of course, the safest course of action is to have a medical provider evaluate the injury right away, which is our recommendation.

We are a phone call away if you need specific and immediate advice.

Take Care.

Dr B.


Delivering Care in All Situations

U.S. HealthWorks' Dr. Cori Repp

We recently asked our providers to share some stories about their experiences in providing care at U.S. HealthWorks. We thought this piece below from Dr. Cori Repp, Center Medical Director of our Bradenton, FL, clinic, was a great example of the diversity of experience as U.S. HealthWorks provides the care our patients need every day.

“Doctor, you’re not going to believe what you’ve got in Room 2.”

I looked up from my chart to see Mary shaking her head.

“This woman was assaulted last night,” she said.

I walked into the room and introduced myself. The patient was an older lady, with a slumped posture. She was visibly upset and had multiple bruises on her legs.

“Please tell me what happened,” I said.

“I was attacked,” she cracked a faint smile, “by a rooster! I’m worried that it has the rabies. I don’t want to get the rabies.” She confided to me in a soft drawl. “I hear it makes you crazy.”

She was actually the second patient attacked by the same rooster. It wasn’t at a farm or a processing facility but in the wooded, scenic garden of a nursing home, where she worked. It took longer to convince her that she wouldn’t get rabies from the bird than it did to treat her wounds.

As physicians, we look forward to challenges that keep our careers fresh and exciting – and keep us on our toes. In our occupational medicine clinic at U.S. HealthWorks, you never know what to expect behind the exam room door.

Occupational medicine is a rewarding field centered on the care of injured workers. Many physicians talk about their love for the field of medicine but express disappointment with the actual practice of it. Not at U.S. HealthWorks. Being part of a dynamic company with one focus greatly improves a physician’s ability to concentrate on the most enjoyable part – patient care.

Our case closure evaluation system is based on choosing the right tools to quickly return the worker to full function. Doctors are encouraged to provide appropriately intensive care to decrease the overall time for an injured worker to recover.

The diversity of occupational injuries keeps even a routine office day from being mundane. When a dog chases a delivery person into a canal and bites him, a provider has to put some thought into antibiotic coverage spectrums. Even routine musculoskeletal injuries become less repetitious when you consider the stories behind the cases. Wrist contusions are common, but how many occur from being squashed under a manatee when the chunky fellow rolled suddenly? I’ve seen three, all caused by the same animal.

U.S. HealthWorks encourages physicians to get to know the companies whose injured workers we treat. We visit companies that are household names, getting a backstage tour to see where the magic happens. I have toured the factory where Chris-Craft boats are born. I saw the entire process that turns Florida oranges into globally shipped Tropicana orange juice. I’ve even been to the nursing home where my patient lost a fight with that territorial rooster.

We treat those who assist us – firefighters, police, EMTs and teachers – when they are hurt in the line of duty. It’s rewarding to feel like an important part of your community.

Every day another exam room door opens to present a new challenge. Working for U.S. HealthWorks provides a variety of opportunities to practice occupational medicine that is as diverse as the businesses we serve.

Watch Your Step: How Businesses Can Avoid Common Workplace Injuries

By Dr. Leonard M. Okun

Businesses usually know how to play it safe when it comes to injuries on the job, but recent trends show that mid-size c
ompanies haven’t been so careful. 

According to the most recent U.S. Bureau of Labor Statistics (BLS), the total injury and illness incidence rate is highest among private businesses with 50 – 249 workers.

Since April is Injury Prevention Month, there’s no better time to remind employees – and refresh employers – about the most common injuries and how to avoid them. 

As an occupational doctor for more than 30 years, I’ve seen a broad range of injuries, but the most common – and completely avoidable – injuries are strains, cuts, punctures, bruises, contusions, and, of course, fractures. 

So how do employees fall into the accident trap? 

Many times the culprit that leads to injury is an object that the employee hits, like a misplaced table that connects with the knee or a heavy box that they misjudge and comes crashing down on their head.

Also not properly using or maintaining equipment – no matter how mundane – often leads to injury.

Not watching where they’re walking, tripping and falling, especially on carpeted stairways if you’re wearing heels.        

Another common one — exposure to known harmful substances or environments like chemicals and pesticides. 

Most, if not all of these, are preventable.

As an employer, ensuring that employees follow all health and safety procedures is a must, but there are many other common sense preventative measures businesses can take to help avoid injuries.

For example, the statistics show that floors and walkways are the most common sources for workplace injuries, so some precautions employers can take include hiding cables that could be in the way, providing warning signs if an area is temporarily slippery or wet, cleaning the floor regularly and providing sufficient lighting and hand rails wherever applicable.

Strains to the neck and back are commonly seen when workers are performing either a repetitive motion or lifting heavy objects. To avoid this, workers should first consider the following:

  • Assess the weight of the object
  • Know your lifting limit
  • Examine the object for potential hazards
  • Ask for help if needed, or divide the load to make it lighter
  • Make sure the area around you is free of clutter
  • Lift with your legs and keep the object close to your body 

While not always severe, ailments from working at a desk are common and can be debilitating to employees. To avoid injuries such as soreness or fatigue, it’s crucial to keep in mind the following:

  • Sit fully back in your chair
  • Your elbows should be bent to 90 degrees with your wrists in a neutral position
  • Your mouse should be located at the same level as the keyboard, immediately beside
  • The top of your monitor screen should be at eye level, except if you’re wearing bifocals
  • For optimum viewing distance, your monitor should be an arm’s length away
  • Incorporate stretching or exercising breaks throughout the workday to reduce neck, lower back and upper extremity fatigue

No matter how minor or severe an injury may be, avoiding workplace dangers is best done through awareness and preventative measures. And while this month may be the time for injury prevention, keeping your employees and workplace safe is something to celebrate every day.

And, in these days when every business is watching its costs, it may also lighten your company’s workers’ compensation claims.

Dr. Leonard M. Okun is the national medical director for Valencia, Calif.-based U.S. HealthWorks, which has 159 clinics and worksites in 15 states.