Cheryl's Blogspot

W The next time I purchase a new vehicle there are several features I have on my wish list.  For as much as we case managers travel, Navigation is high on the priority scale to make life easier.  Under the pressure of arriving at a physician appointment on time, it's never a good feeling to take a wrong turn or get lost. There are times our role as a case manager is much like a navigator. Deana Scott, RN had that experience just yesterday while attending a physician visit.  After three years of treatment for a work injury, the physician had nothing further to offer, and there appeared to be issues of malingering and symptom magnification.  There was a point at which the physician actually had a look in his eye of being lost as  far as how to bring the treatment course to an end.  Confusion centered around  the injured worker's return to work goals.   It's at times like this, a Case Manager is able to maintain focus and much like a navigator, help the physician to ad

Whether you know the song from the Madagascar movie or Apollo and Julianne's performance on Dancing with the Stars, this is such a catchy tune! And it came to mind when I read an email update from Stacy Mathis, RN just now.   Stacy's client just completed a progress evaluation with her surgeon, and is doing well, but additional healing and therapy time are needed before medical release.   One principle we adhere to at JMS is regular and timely intervals for physician follow up. Providers that don't understand WComp may suggest a 6 or 8 week follow up appointment.  Our CMs request monthly return visits, as too much can change for the better or worse during that time frame in the recovery process.  In this case, Stacy assured the return appointment was scheduled appropriately. Additional healing time may still be indicated, but work restrictions could likely be relaxed, helping out the employer, and actually contribute to the client's strengthening in prepara

I have done presentations on The Benefits of Case Management to carriers, peers, and other health care professionals.  Sometimes it sounds dry and philosophical to list benefits: access to care, best practice recovery, lowered cost expenditures. But who is the one that benefits?  In our practice, is it the injured worker? the employer? the insurance carrier? From the Case Management Society of America, "It is the philosophy of case management that when health care is appropriately and efficiently provided, all parties benefit." Allow me to demonstrate for you the heart of case management from two of our case managers this week. One of our CM Team has a patient that was "swimming" amidst a work injury and numerous mis-diagnoses and was fearful this CM's job was to just "write him off." Our RN worked to find a physician that would clarify his diagnoses, even collaborating between his group health carrier and Work Comp carrier.  At the conclusion of a

Our Case Management role is so multifaceted.  While we are patient advocates to help injured workers obtain the best treatment on the road to healing, we also find ourselves working the other side of the fence - working just as hard to expose those defrauding the workers compensation system.   This week one of our RN case managers discovered in review of records that a patient had "chronic" back pain, when she had denied ANY pre-existing back pain or treatment for her reported work injury.  This patient DOES need treatment, but it should be on her health plan, NOT workers compensation.  On the other side of the fence, he has a patient that was discovered to have a serious underlying cancer causing what he thought was pain from a work incident.  He is working with the carrier to refer the patient to an appropriate provider. Case Management is such a rewarding field, and for so many reasons.  It's a great feeling when you've assisted someone to obtain treatment

When we are taking care of treatment arrangements and details, calling clients for updates and problem solving, attending physician visits with clients - sometimes with lengthy wait times, we establish a professional relationship with them.  From the client's perspective it can seem even "personal", although it's overwhelmingly a 1-sided sharing of information.  This is true not only in case management, but in every field of nursing, because nurses show empathy and compassion for others as we provide "care" for them. I caution adjusters and carriers not to think of case manager tasks as clerical, or messengers, or that our clinic wait time is a "waste" of time.  All our communications with clients are taking care of their needs - "medically" physical and emotional.  The results of our nursing can seen not only in the gathering of information, treatment planning, but also in improved patient compliance and understanding, and outcomes.

My first test in college anatomy we were given a piece of paper with numbered lines, 1-206.  Instructions were simple:  Name the 206 bones in the body.  I made 100% - thank you. Learning anatomy of all the body systems, and the physiology of how they interact is my love in the medical field.  The science of it all fascinates me. There is a logical physiologic reaction to bodily injury, and a RN Case Manager's critical thinking skills help anticipate symptoms and complaints.   If you hit your thumb hard with a hammer, we know you will have pain, and probably stiffness; and if you smashed it good enough, you could have "sympathetic" stiffness of adjoining fingers in the hand.  That is a known physiologic response. Stacy Mathis, RN has a patient with multiple injuries has begun to relate all aches and pains to his MVA.  The problem is, not all his complaints can be physiologically connected to the injury.  This is quite common in catastrophic injuries, but also ha

Fresh out of nursing school I worked in a busy Internal Medicine physician group.  I had thought it would be my dream job, but after several months went by, for me it actually became a daily dull-drum of  scheduling tests, refilling prescriptions, and  tearing table paper.  I remember getting excited when a patient needed a joint injection so I could prep and assist with a procedure!  I know that sounds creepy to some.  It's a nurse thing; some don't understand. Nowadays as a Case Manager, it's still a thrill when an injured worker needs a joint injection, or a trigger point injection in clinic; Because I know this is something that will likely give that patient quick relief from their pain, and at the very least be diagnostic to clarify the pain generator.  These injections typically consist of a lidocaine, an anesthetic to numb the area, and a steroid, which acts to reduce inflammation and promote healing.  This is a wonderful thing.   One of the tools we

The human body is a masterpiece created by God. One of the many fascinating things about the human body is the way it can adapt to our environment and activities.  If I were lost on a dessert island away from readily available food, and cheesecake, I could survive for weeks on my fat stores.  If I p erform an activity requiring heavy lifting and carrying, my body would build muscle mass to help with that task. Even my bone density in my legs would increase to strengthen my supporting frame. The antithesis is also true; if I stopped that heavy lifting/carrying, muscle mass and bone mass would reduce, since it isn't needed anymore.  Similarly, when the body is injured and an extremity is not used due to immobilization or pain, muscle mass is lost, and joints can become stiff.   Stacy Mathis, RN had a case this week where the injured worker had guarded her shoulder due to pain and soreness of the accident, and was close to having a frozen shoulder. A frozen shoulder, or

You might be a boomer if:       The Beatles                                                   You know why they call it "dialing" a phone You researched a topic using your parents' set of encyclopedias  You remember Joe Namath in pantyhose As our case managers log in their case updates, I noticed several claimants that are baby boomers, injured in the workplace.  Stacy Mathis, RN just closed a file on an injured fireman.  His work injury involve several body parts, and his treatment planning had to take into consideration a pre-existing knee surgery and mental depression. From day one, this injured worker stated his goal was to get back to work, which he did achieve.  Jackie Cooper, RN has an ongoing file where the injured worker was just shy a few months from retiring, and will lose all benefits if she cannot complete her tenure.   Case Management of aging employees takes into consideration these 3 key factors: Comorbidities - the older we are, the