Work Disability: It is not just the “lesion”

I used to be an orthopedic surgeon. When I was an undergraduate medical student, I was fascinated by the brain, as it looked to me the most mysterious part of the body and I registered for my first rotation in neurosurgery at a famous neurological hospital in Paris. Unfortunately at this time, neurosurgery was far less advanced than now and most patients had severe trauma or advanced tumors. The wards were filled with comatose patients and in the Operating Room, the concussed brain was suctioned ... My next rotation was orthopedic surgery. I found the fundamentals and action of rebuilding what was sick and broken, leading to functional recovery very appealing. The spine combines bones and nerves in a complex interesting way and I became a spine surgeon. Twenty years and many spine fusions later, I had accumulated excellent fusion rates with splendid X-Rays. Alas, I followed up with many patients who were experiencing pain as before or worse, were disabled, and unable to return to work. Many of these patients were even crying at follow up due to their distress. I progressively realized that the book chapters and clinical papers that I was reading and applying in practice might not always tell the truth or the whole story regarding the treatment of spinal osteoarthritis or other sources of “mechanical spinal pain.” Also, filling Workers Compensation Board (WCB) or other insurance forms out for patients, I realized that the more I fused, the more the disability was being created in the forensic attribution of compensation, as every new fusion was considered to add disability instead of improving the patient’s status. Some colleagues having obviously similar results were telling me that many patients were just “too lazy to return to work” and happy to combine surgery with benefits. I could not accept that. I could not accept that my “successful surgical procedure” led to overall failures in the lives of my patients. One day, the dean of my School of Medicine asked me: Dr. Loisel, your colleagues, the neurosurgeons, tell me that they send you patients with failures of disc surgery and that you refuse to operate on them. Why? I answered: because, most of the time, I know now that I cause more harm than good: I cure the lesion but I increase the disability. My colleagues as well will recognize this in ten years from now. I was committed to provide the proof.