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Citation |
Harris IA. ANZ J. Surg. 2007; 77(8): 606-607. |
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Affiliation |
Department of Orthopaedic Surgery, Liverpool Hospital, Sydney, New South Wales, Australia. |
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Copyright |
(Copyright © 2007, Royal Australasian College of Surgeons, Publisher John Wiley and Sons) |
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DOI |
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PMID |
17635266 |
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Abstract |
As a trainee, many years ago now, I was frequently confused by the negative attitude towards patients receiving compensation that was held by some surgeons. Later, when treating my own trauma patients, I was again confused as to why my compensated patients seemed to have poorer subjective outcomes than their uncompensated counterparts. With further reading, I was surprised to find that, although the negative association between compensation status and outcome was widely reported, it was not new, dating back to such 19th century complaints as 'railway spine' which nearly bankrupted the railway companies in Victorian England. This phenomenon has raised many questions, such as: is the association real, what is the magnitude of the effect, and what is the mechanism of the association? Answering these questions has been made difficult by the myriad of legal, compensation and insurance systems used and by frequent changes within these systems over time. In New South Wales, for example, there are many systems by which patients may receive compensation, such as the workers compensation system (a no-fault system), the third party motor vehicle system (fault based), public liability and other forms of litigation through the courts. The question of the reality of the problem refers to the veracity of the complaints made by these patients. Although there is some evidence of conscious deception (malingering) in compensated patients (for example, much has been made of the Waddell et al. signs of symptom exaggeration), it appears that compensated patients who report more symptoms than their uncompensated counterparts believe these symptoms to be true, regardless of how believable others may find them. This, by definition, makes them real. Given that the effect is real, what is the magnitude of the effect? This report investigates this issue. Language: en |