Susan Zickefoose, M.D. is the latest physician featured in our series about best practices in workers’ compensation. Dr. Zickefoose currently works for CareNow Urgent Care & Occupational Medicine. Based on her performance in Pinnacol’s clinic profiling report, we asked her about how she cares for injured workers.
Zickefoose: In 2003, I was moving from Pennsylvania to Colorado and, unfortunately, my husband was sick with cancer. I was looking for a job that was Monday through Friday, 8 a.m. to 5 p.m. I found Centura Centers for Occupational Medicine (CCOM) in Canon City and I worked there for three years. That's how I got started. I’m board certified in family practice and missed getting to know patients and ongoing care. It started as a job that was needed at the time, but then I found that I enjoyed it.
Zickefoose: It would be getting to know the patient and having a relationship with them instead of “Hello! How are you? Now follow up with your family doctor.”
Zickefoose: There are three: the patients themselves, the employers, and the insurance company. A lot of times, the patients are afraid of losing their jobs and they will go outside what I've told them that they should be doing and then wonder why they're not getting better.
Most employers are very good and follow what I write down. But there are some employers that I might as well not even waste the ink.
And then insurance companies in general. Some are better than others, and I’m not saying this because I’m being interviewed by Pinnacol, but Pinnacol is one of the easiest ones to work with. But when insurance companies use third party administrators it slows the process down. Then they want to know why the patient is not back at work. Well, maybe it’s because it took the insurance company three weeks to approve what I wanted to do with the patient to get them back to work. It’s a combination of everything that makes it hard some days to treat the patients.
The biggest challenge is non-English speaking patients. Whether they speak Spanish, Arabic, or Chinese, if English is not their first language, it’s more difficult to treat them, even with translators. You also need to take cultural differences into consideration. Too often I see cultural differences are not addressed. What culture the patient comes from makes a big difference in how you treat them. People don't always understand the cultural differences and how illness and what is going on with their care is perceived differently.
I’d also say another challenge is when the patient believes the employer is not listening to them and doesn't care about them. In these scenarios, it's harder to get the patient better. I wish I could say to all employers not to treat injured employees like they got hurt on purpose and that they didn’t get injured to screw up their schedules. That's one of the biggest challenges for me when the patient feels like the employer doesn't care about them as a person.
I want to encourage all employers to let the patient come back to work. I don't care if they sit there and read a book. Don't send them home because you don't have anything for them to do. I guarantee they’ll be better faster if you let them come to work because then they’re still part of the team and they're still interacting with their co-workers.
Zickefoose: It is to get them back to their life and not get them back to work. Work is only part of their life. My philosophy is, “Get them back to their life.”
Zickefoose: To explain to them how the system works. I explain what they can expect, how we're going to move forward, and simple things like even if I order something, it still may need to be approved.
One of the other things I do at every visit is explain to them that I'm going to send them back to work. It may not be their regular job, but it is beneficial for them to go back to work and to get their full wages. Too often the patient will say they can't do their regular job and I’ll tell them I don't expect them to do their regular job. It’s better if they go to work even if they just sit down and read a book. When they understand they're not expected to go back to their regular job, then most of them are okay with it.
There are some that ask how they will get back to work when they still hurt. I’ll explain they can sit at work and hurt or sit at home and hurt, but if I made their restrictions reasonable, they are not going to harm themselves more. Going to work gets them out of the house and keeps them mentally ready to continue to work.
Convincing these types of patients that it's beneficial if they go back to modified duty is one of my biggest challenges.
Zickefoose: On the positive side, we're open seven days a week. Patients can walk in and don’t need appointments for their initial visits. That is beneficial because if you get hurt at 8 a.m. on a Sunday morning, you can come in and be seen as opposed to waiting unitl Monday to go somewhere or going to the emergency room, which is probably overkill.
A little bit of the downfall with the urgent care, up until recently, is having to wait because there are so many urgent care appointments and the provider has to fit the workers’ comp patient in between and the work comp patient may need to wait even if they have an appointment. But now the clinic has me doing occupational medicine for them. I think the urgent care setting is good, but I think these types of clinics should also have occupational medicine doctors so that when patients come back for their re-checks, they're seeing only one person and not multiple people. If there are no occupational medicine doctors on hand, the patients may see multiple people and I don't believe that is good care.