June 1999 Bulletin

or Fiction? OSHA adds fuel to debate

By Michael I. Vender, MD

The proposed Ergonomics Program Standard of the Occupational Safety and Health Administration (OSHA) can be described at best as misguided and more likely detrimental to patient care. Its stated purpose is to "reduce the large number and severity of work-related musculoskeletal disorders (WMSD) employees have been experiencing." The "large number" of cases is best explained by the unreasonable definition used in the Standard for work-related musculoskeletal disorders. To quote a fellow Chicago physician referring to carpal tunnel syndrome, "to the best of my knowledge, the above condition was a result of occupational nature until and unless it is proved to be otherwise something else." Similar logic prevails in the proposed Standard. Therefore, any person who has a musculoskeletal complaint, which happens to encompass a large part of the general population, but who is employed will be included in this "large number" and this number will grow without limit.

OSHA is concerned about the "severity" of conditions. And the inference is made from review of the proposed standard that those jobs with the higher levels of physical demand will result in the higher number and more severe cases of WMSD. Yet, why is it that the most difficult patients to treat, those labeled with cumulative trauma disorder, repetitive strain injury, fibromyalgia, myofascial pain syndromes, etc. are employed in the less physical jobs? Even more confusing is the fact that OSHA's proposal would not even include the more physical challenging industries such as maritime, construction and agriculture.

Another issue with the standard is the vague and ill-defined key terms such as WMSD "hazards", "reasonably likely" to cause or contribute, and "significant part" of the injured employees "regular job duties"

The program is required when one WMSD is identified in a work place. A trigger this low will pull all places of employment under the effects of this standard. This is in contradiction to OSHA's indicated scope of being "limited to workplaces in general industry" involving manufacturing or manual handling. The program is to continue and be continually monitored and amended until all WMSD are eliminated. For example, this program will apply to any doctor's office that may have older aged employees who may have neck stiffness, achy joints or sore thumbs. Is it possible to eliminate musculoskeletal complaints in an aging working population, let along a young one?

OSHA's premise is that physical use of the musculoskeletal system is "cumulative" and detrimental. The resultant goal is therefore the elimination of all physical use/activity. There is no reconciliation of the contradiction that upper extremity use is reportedly bad at work yet is encouraged for conditioning and rehabilitation. On the contrary, lack of use causes atrophy and osteoporosis.

An employer must provide to a treating physician a job description, results of the hazard analysis, description of alternative jobs, a copy of the standard with "medical management requirements pointed out" and opportunities to conduct workplace walkthroughs. In return, the doctor's opinion "must contain" the work-related medical conditions, work restrictions, statement that you have informed the employee about results, a statement that you have informed the employee about "other physical activities that could aggravate the WMSD during the recovery period." A doctor would have to restrict the nonwork activities to the same degree as the workplace (examples: no repetitive motions, no use of the affected arm, no lifting over 5 pounds, no sports/recreation, no lifting of children, etc.).

You must ensure employee privacy and confidentiality regarding medical conditions identified during medical management. The employer must instruct the doctor not to reveal findings, diagnoses or information that is not related to WMSD hazards in the employee's job. What about medical conditions that my contribute to musculo- skeletal complaints and disease such as diabetes, thyroid disorder, connective tissue disease, smoking habits, alcoholism, drug abuse, physical abuse, psychiatric illness, etc.?

In summary, the proposed standards from OSHA set out to do the impossible, that is, eliminate musculoskeletal complaints in the workplace. It is not reasonable to assume this is a realistic goal unless one is able to prevent aging, and the other numerous conditions that contribute to musculoskeletal complaints in the general population. OSHA's proposed ergonomic standard would place the burden of this endeavor upon employers and health care providers. The proposed standard is misguided because it directs the efforts of these groups and the associated expenditures of time and money towards the unproven panacea of ergonomics and away from numerous other well-known, more thoroughly studied contributors to musculoskeletal disorders.

Michael I. Vender, MD, is in private practice in Arlington Heights, Ill.

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