The American Association for Disability Policy Reform    

—   rehabilitation first   —

For Physicians and Psychologists


SUMMARY:

Physicians and psychologists, particularly those who work for the Social Security administration, are asked to determine what work activities disability applicants are able to perform 40 hours a week on a sustained basis.   Because the completeness and accuracy of the information they are given is not verified, and because medical records are almost always poor sources of information about a person's ability to sustain work activities, and because the examinations to which the Social Security Administration sends applicants are of little value, and because there is no reliable method for evaluating subjective claims (pain, fatigue, etc.), except in cases of extreme impairment, it is dishonest for a physician or psychologist to claim that he or she is able to make the requested evaluations accurately.

Here is a statement that physicians and psychologists who are asked to evaluate persons other than their own patients should add to their assessments.   "This is an attempt to determine what activities the disability applicant is able to perform on a sustained basis, as needed in a job.   Neither the accuracy nor the completeness of the information on which this assessment is based has been verified.   The medical records on which it is based provide little usable information about the activities the applicant is able to sustain as needed in a job.   The examinations to which the applicant has been sent are of little help.   With no reliable method for evaluating claims of pain, fatigue and other subjective factors, this assessment is little more than a guess and should not be relied upon."   However, those who work for the Social Security Administration should have a second job to which they can turn because few Social Security administrators can tolerate this degree of honesty.


DETAILS:

Physicians and psychologists in practice are frequently asked to determine a person's suitability for work.   In addition, about 2,000 physicians and psychologists are employed by the Social Security Administration to examine medical records and then to try to determine a person's suitability for work.   For almost twelve years I was one of them.

In these cases, the challenge to the physician or psychologist is to determine what work activities a person is able to perform (or not perform) 30 to 50 hours a week on a sustained basis, as required for most jobs.   Because there is no reliable method for evaluating (a) a person's effort or (b) the effects of pain, fatigue, anxiety, an inability to concentrate or other subjective factors on a person's ability to work, there is no reliable method for determining what work activities most applicants are able to perform 30 to 50 hours a week on a sustained basis (details).

To make matters worse, the Social Security Administration does a very poor job of collecting information about applicants for disability benefits (details).   The questionnaires it has applicants fill out are practically worthless and it assumes, incorrectly, that medical records are good sources of information about the ability of persons to sustain work activities.   Except in cases where the individual's disability is so severe that it is extremely obvious, medical records are poor sources of information about the person's ability to sustain work activities (details).   In reality, it is usually much more difficult to get to know and understand disability applicants than we might expect and it takes a great deal of time, face-to-face contact and effort to do this.

Having no reliable method for evaluating subjective factors (pain, fatigue, etc.), and with the additional burden of having poor information about disability applicants, physicians and psychologists working for the Social Security Administration are forced to rely on personal bias and to guess.   Their high error rate has been documented in good studies (details).   As they mislead themselves and the public into believing that they are able to evaluate applicants' abilities to work, applicants are injured by their false negative decisions and taxpayers are injured by their false positive decisions.

PHYSICIANS: Except in cases where the individual's disability is so severe that it is extremely obvious,

PSYCHOLOGISTS: Except in cases where the individual's disability is so severe that it is extremely obvious,

For almost twelve years, I evaluated disability applications for the Social Security Administration.   Now that I have worked as an advocate for applicants, I realize how poor the information was that I was given and how wrong I was to pretend that I could evaluate persons without having first met them, having obtained their trust, and having spent the necessary time with them, their family members, their neighbors and their past employers and made the required effort to get to know them well.   I regret the injuries to applicants and taxpayers which my many errors caused, and I regret having helped the Social Security Administration promote the misconception that its methods are valid and its determinations are accurate.   I urge other physicians and psychologists to recognize the great difficulty, if not impossibility, of determining the ability of most applicants to sustain work efforts and to avoid the errors which I made for so many years.

The proper role of the physicians and psychologists who work for the Social Security Administration is not in an office cubicle fabricating "assessments" of people they never have met and don't know but out in the community, face-to-face with those who are suffering from disabilities, offering to help.

Alan L. Cowles, M.D., Ph.D.


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Last updated on 2/25/2015.