Medicalization and Subjective Conditions for Employers

Jul 5, 2018

Medicalization can make non-problems much worse

You’ve got an employee complaining of a medical issue you’re just not sure about. Where to start? Well, when it comes to diagnosing a “real” medical problem, it’s helpful to think in terms of a spectrum.

At one end is outright malingering. This is when a person is inventing or exaggerating issues for personal gain — i.e., they’re well or minimally ill but want paid leave. Needless to say, that slows down the return to work process. At the other end are pathological issues. These can be objectively observed, such as a serious disease or a broken arm.

In the middle lie somatoform disorders. These are issues the patient very may well be genuinely feeling, but they’re difficult or impossible to nail down objectively. When it comes to an employee’s return to work when they’re reporting one of these, it’s easy to run into trouble fast.

The Subjectivity of Somatoform Disorders as a Medicalization Risk

With no ability to objectively verify and treat a condition, a somatoform disorder is at risk of medicalizing a patient. As we described here, medicalization is what happens when a non-medical issue Is elevated to the status of medical problem.

The cause of a somatoform disorder can’t be identified, but the employee has many avenues for their experiences to be solidified into the belief that they are more ill than they are. A sympathetic GP may write notes for continual disability and treatment. Non-evidence-based treatment can exacerbate the issue, family and society-at-large can validate it, and as with any issue, the internet is able to tell anyone anything they want. 

Common Somatoform Disorders

It’s common to see a somatoform disorder described as chronic pain or vague neurological complaints. What should an employer watch out for?

Fibromyalgia

This is a medically controversial condition, with sufferers complaining of pain, feeling tired, and having issues sleeping. However, there is no known cause, and it’s only diagnosed after ruling out other conditions.

Myofascial Pain Syndrome

This one involves pain in soft tissues (muscles or fascia) anywhere in the body. There is also often reported tenderness and restricted range of motion. But again, the cause is not known, and the symptoms are subjective, which makes it hard to treat.

Chronic Fatigue Syndrome

Another is example is chronic fatigue syndrome. A person with this may complain of being tired all the time and having a significantly harder time doing things that should be routine. It may occur gradually or suddenly. Again, the symptoms and diagnosis are vague.

How Should an Employer Support Their Employee and Return them to Work?

Several things tie all these and other conditions together: the cause is unknown, many details are vague, and there are no objectively verifiable aspects whatsoever — your employee may well be feeling what they say they are, but you wouldn’t be alone if you have questions about it.

With plenty of para-professionals in every shopping mall ready to take advantage of the medicalization of individuals, your employee risks getting sucked into a process that isn’t good for them at no fault of their own. This could result in missed return to work dates, and a worsening condition all the way up to permanent disability.

What’s best for the company is a healthy employee, not one that ends up on long-term disability and isn’t able to work again. What can help get that is an independent medical examination (IME). If you’re worried that an employee’s medical absence and recovery isn’t on the right track due to the possibility of medicalization, give Western Medical Assessment’s Dr. Roger Hodkinson a call at 780.433.1191 to understand what your options are. Or, find out more about medicalization in work issues here.

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