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Read the slides alongside this

  • Asbestos includes blue asbestos and crocidolite
  • Australia - kept using asbestos into the 70s despite known consequences
  • Still using asbestos in Canada
  • Enclose/remove source of hazard, wear masks, improve ventilation
  • PPE is meant to be a last resort, but employers go straight to this (cheaper) - but people don't actually use PPE
    • Deafness is #1 cause of workers comp in Australia
  • Farming, Forestry and Fishing - highest risk occupations
  • Scandinavia: more sophisticated and organised
  • Latency period for neoplasm = 10-20 years. This means we can't know the long-term effects of new technology without waiting this long
  • Pain when unhappy -- worse
  • If someone has backache, don't send them to bed - they lose 3% of striated muscle every day
  • Red flags for back pain:
    • Cauda equina compression - urinary incontinence or retention;
    • Check for malignancies etc
  • USA: CT scan people every year --> cancers
  • Radiculopathy: weakness, numbness, loss of reflexes due to nerve injury
  • Disc bulge or herniation with no symptoms - don't do anything about it.
    • Better off not knowing if there's nothing you can do about it
    • People who are given their results do worse because they worry. If you're convinced you're sick, then you get sick
  • Rotator cuff tear: pre-test probability of MRI is high, so predictive value is bad. Instead, rely on symptoms and signs.
    • MRI diagram validates their misery (which is psychosocial). They have to remain positive and active.
    • Knee injury: meniscal tear - surgery actually results in OA in median 13 years
  • Don't create psychopathology by overtesting (1/20 will be abnormal)
  • If you operate on people who have been injured in work, they do badly. They're disastrous when they've had multiple procedures. Iatrogenic problems. Better off to deal with their psychosocial problems.
  • Most people have pain. Those who seek treatment are those who aren't coping.
    • People who are motivated go back to work
    • For the aches and pains of daily life, there is no point in operating on them
  • When you get old, things go wrong and never get better - all you have to do is be happy.
    • Work is NOT bad for people - it's GOOD for people. It's unhealthy to NOT work.
    • Unemployed = poorer health
  • If you tell people it's good to be working, then they are healthier. The longer people are off work, the sicker they are.
    • The longer people stay off work, the more likely they are not to go back to work.
      • Even though almost all of them are fit to work
  • THE LONGER YOU SANCTION INCAPACITY, THE WORSE PEOPLE ARE GOING TO GET.
  • The solution: reassurance, CBT, psychotherapy, exercise.
  • Conflict of interest: the more clinicians do to people, the more money they make. THIS IS NOT RIGHT.