Today’s final half day of the General Session of the MASI Annual Conference at the Beau Rivage in Biloxi was another varied line up of three speakers. Although the exhibit hall was largely empty, the conference room was full and at attention for these last sessions before official adjournment. The first two sessions, from 9 AM until 11 AM, were the most significant for the world of workers’ compensation.
Starting the morning off was Dr. B. Heath Gordon, a neuropsychologist with the VA Medical Center in Jackson. His presentation focused on cognitive decline as the baby boomer generation (generally understood as those individuals born between 1946 and 1964) ages while still in the workforce. Dr. Gordon’s detailed discussion, though technical, managed to bridge the gap in the audience between those who practice and encounter medicine frequently and those who do not often do so. And his own multidisciplinary field seemed especially suited to this task.
In an exploration of workplace duties and difficulties in “older” people (for purposes of discussion in the American context this was set at 65 and older) Dr. Gordon delineated what the differences are between normal and abnormal cognitive aging. In particular, he emphasized the importance of baselines and how ordinary individuals rarely assess their own cognitive abilities and thus, are fearful when they have memory challenges later in life. He gave a personal example that seemed especially poignant, explaining, “Sometimes I’ll park my truck somewhere and forget where I parked it…now, it stands to reason that if I’m doing that now I’ll still be doing that later in life.” The point of the scenario being that those individuals who already struggle with occasional minor lapses in memory in their youth and middle age will likely do so in their old age, but the narrative of dementia dictates fear. Instead, Dr. Gorgon gave a systematic and reasonable picture of normal aging which includes a variety of cognitive difficulties.
The main takeaway appeared to be the assessment of daily functioning: when cognitive issues begin to affect one’s daily life and attract the notice of others, it’s time to get evaluated. Dr. Gordon was also at pains to challenge typical notions of “older” workers, and explained age bias as a very real obstacle for people who choose to keep working with normal cognitive aging. He also provided several interesting examples of patients who presented symptoms of dementia but in fact were suffering from complications due to other illnesses such as severe urinary tract infections, undisclosed head trauma or depression. Ultimately, Dr. Gordon seemed especially to concern himself with preparedness for the upcoming challenges of the aging workforce, and urged employers to make adjustments for their valuable older employees, whose experience, he added will retire with them without proper arrangements.
Immediately following Dr. Gordon’s well-received talk was Dr. Moriarity’s discussion of cervical radiculopathy, a major issue in the treatment and expense of workers’ comp claims both in Mississippi and here in Louisiana. Once again, though the presentation was technical in nature, Dr. Moriarity (a surgeon with NewSouth NeuroSpine and graduate of Stanford undergrad and med) did an excellent job of explaining the practical aspects of anatomy and function. His presentation, particularly the part which focused on and explained diagnostic procedures, provided much in the way of clarity for the carrier side of the equation. He explained how MRI can be inadequate and why repeat diagnostic tests must be performed in order to make the important final determinations as to whether or not a patient is a candidate for surgery. In terms of this anatomical detective work, Dr. Moriarity repeatedly made a rather profound statement that, “Surgery is a structural solution to a structural problem.” In other words, a neurosurgeon may be able to identify and substantiate the claimant’s complaints of pain and identify what the anatomical source of that pain likely is, however, if the detailed and varied imaging does not reveal a significant structural problem, surgery is very unlikely to help that patient. To further emphasize this point, Dr. Moriarity explained, “Even with low risk surgeries, where that incision is really small and there’s not a lot of risk overall, because that patient is unlikely to get any better afterward, that risk is infinite in comparison.” Further, he revealed some of his diagnostic methods to the audience and eventually said that, though it may be difficult for the patient in pain to understand, the decision to have surgery, at the first level of analysis, needs to be the surgeon’s; again, because of the structural dynamic.
Despite the smaller last day crowd, the final hours of the MASI conference were yet again an informative joy, especially from a workers’ comp perspective, simply because of the level of detail and the caliber of information. As the attendees filed out of the Beau Rivage, you could already here tittering about next year’s conference. As for now though, I believe MASI can call number seventeen a success.