Gender Matters

Gender.  It’s all over the news for a variety of sensational reasons that have nothing to do with independent medical examinations.  Nevertheless, gender can be important in independent medical examinations.  For example, a study published online in Radiology finds women who sustain mild traumatic brain injuries have significantly greater working memory impairment which persists for longer periods than men who suffer mild traumatic brain injury.  In managing a claim file with a mild traumatic brain injury, this information is important for at least a couple of reasons.  First, it should help gauge when a claim has gone from an expected recovery pattern to an unexpected one.  If we know that men typically do not experience working memory impairment in mild traumatic brain injuries beyond 4 weeks and a claimant is still complaining of memory problems beyond that time, we should certainly be asking questions of the provider and may wish to consider setting up an IME to get a second opinion.  Conversely, if a woman who suffers a mild traumatic brain injury complains of working memory problems 8 weeks after the injury, we should not necessarily be alarmed.

Second, knowing the differences in the way persons of each gender respond to common injuries and conditions can help us tailor our questions to the IME doctor.  Certainly in the mild traumatic brain injury example involving a male claimant we would want to specifically ask whether claimed working memory impairment past four weeks post-injury would be unusual for a male.  In this way, we can use a question to alert the IME doctor as to why we think something is remiss in the claim and to elicit a specific explanation that will bolster the basis for the doctor’s opinion.  Another example of a gender-specific response involves whiplash injuries.  The medical literature demonstrates that female gender is associated with greater risk of whiplash injuries resulting in chronic or permanent complaints.  If we have a male claimant alleging permanent whiplash-type injuries without objective evidence of ongoing injury, we would want to direct the IME doctor’s attention to whether this is consistent with the literature on how male bodies respond to whiplash.

Beyond medico-legal claims, gender matters also.  A lot.  Take heart attacks.  Most people know that squeezing chest pain is a symptom of heart attacks, often described “like an elephant” sitting on the chest.  Far fewer people know that “women can experience a heart attack without chest pressure.”  Also, according to the American Heart Association, “women are somewhat more likely than men to experience some of the other common symptoms, particularly shortness of breath, nausea/vomiting and back or jaw pain.

Why is this significant?  First, heart disease kills more men and women than all forms of cancer combined.  Second, the key to surviving heart attack is early intervention.  If we do not differentiate heart attack symptoms by gender and educate people accordingly, more than half the population is at increased risk of death from the leading cause of mortality simply because they lack basic, simple knowledge.  This increased risk has nothing to do with age, wealth, health insurance, race, etc.  The only reason for the increased risk is that the former one-size-fits-all-genders approach to medicine forgot a simple truth:  men and women are different.

In the medico-legal world we administer claims of both male and female claimants.  To fulfill our responsibilities most effectively, we must recognize that men and women are biologically different in ways that can affect the outcome of a claim.  We must be aware of the physical conditions and injuries to which men and women respond differently so we can differentiate between what is normal and what is not, so we can know when to get an IME, and so we can ask the right questions once we schedule an IME.  Injuries are not “one-size-fits-all-genders” any more than heart attacks are.  Knowing this will make us better claims handlers, nurse case managers, paralegals, and attorneys (and it might help save a life, perhaps even yours).

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