Kathryn Bird, D.O., is the latest physician featured in our series about best practices in workers’ compensation. Based on her performance in Pinnacol’s clinic profiling report, we asked her a few questions about return to work and how she keeps her temporary total disability days low.
Why did you decide to get involved in the treatment of injured workers?
Bird: Initially, I decided to go into occupational medicine because it had a good work-life balance. I was doing family practice and had small children. At the time, it was tough trying to balance being on call. I was running to the hospital to deliver babies in the middle of the night when I had my own babies at home. Occupational medicine definitely provides more protected time at home and less time on call.
Plus, I had a friend who was practicing occupational medicine and loved it. She was so excited about it, it encouraged me to pursue it too.
What do you enjoy most about the treatment of injured workers?
Bird: Knowing you can really make a difference. We treat so many people who serve other people in the community. We see a lot of teachers, CDOT employees, people who work at the grocery store or your local retail stores, and the police department. All these people are vital to the city of Littleton and to us. You feel a lot of value giving back to those people because they are so critical to so many others.
What are some of the biggest challenges you face when you care for injured workers?
Bird: The toughest thing for me is the people who are not sure they can get better and trying to help them work through that mentally. It can be challenging but rewarding to see how their recovery improves their lives. It’s also challenging when you have injured workers who are discontent with their employers. The injured worker not only has to deal with a physical issue, but an interpersonal one with their employer. It’s challenging to have to navigate the wants and demands of the patient, their employer, the insurance company and my employer. They don’t always want the same thing or agree how to approach it.
Do you change your treatment plan for an injured worker if that injured worker has the mentality that they can’t get better?
Bird: I do my best to explain what the injury is, what the expected progression is, what I see for them, and what I see as their path to recovery. It’s unique for everybody. If they believe their condition will get better and they see improvement along the way, they’re reassured they can have a good outcome.
What is your philosophy for how you care for injured workers?
Bird: I treat people how I want to be treated. They want to be respected. They want people to understand what they’re going through and sympathize with them. They want their concerns, complaints and worries about what’s happening with them physically and mentally recognized. They want to be heard about how it’s affecting their family and their work life. If I can relate with them, they appreciate it. I also make sure I’m doing things that are helping them. And if what I’m doing isn’t helping, I try different treatments to find what works for them.
What are some of the important things you discuss with an injured worker during the first visit to the clinic?
Bird: I discuss their injury, diagnosis and expectations for recovery so they know what to expect going down the road. I specifically touch on medications, treatment and restrictions. I always give them a chance to ask questions and voice any concerns they have. It’s important for them to know I’m open to their feedback and will listen to what they say.
When we reviewed your performance report, your temporary total disability days, regardless of injury type, were significantly lower than those of your peers. Why do you think that is? What do you do differently?
Bird: I’m not sure what everybody else is doing, but I’m always talking about restrictions and revisiting them at every visit. For example, I’ll review what the restrictions are today and ask the injured worker if they are able to do more. Most people are really invested in this process. I have them continually reevaluating themselves to see what they’re able to do. I’m fortunate that my patient population is generally motivated to get back to work.
There are injured workers who think they cannot do more than they are already doing. They’re scared about reinjuring themselves. I encourage them to try to do more. If it doesn’t work, that’s OK, but I reassure them I think they’re ready for the next step. Giving them confidence in their condition and letting them know their hesitation is common gives them reassurance to forge ahead.
What is your approach to return to work?
Bird: From early on I keep talking about what to expect and when I see things getting better. I keep reviewing the injured worker’s timeline so they have good expectations from the beginning. As far as getting them back to work, by setting those expectations, it makes it easier to advance restrictions as the injured worker is ready to do so. These conversations are especially important for people who are a little resistant to returning to work so they can mentally prepare themselves to return to a job where they were injured.
When someone is more resistant to return to work, does that change your treatment plan in any way?
Bird: If an injured worker has concerns about returning to work, I talk to them about it to let them know it is a common concern people have. Gradually advancing restrictions also makes it easier for the injured worker to return to work rather than leap to returning to full duty. If an injured worker has developed a lot of fear about their situation, it can be helpful to develop coping mechanisms through a referral to a psychologist.