Hadler N M
J Occup Med. 1986 Oct;28(10):940-5. doi: 10.1097/00043764-198610000-00010.
Disability determination in the US is traditionally based on the classical medical disease-illness paradigm: if one defines the quantity of disease (pathoanatomical abnormality), one can predict the magnitude of illness (symptoms), including how the illness will operate in the workplace. This inference underlies the Handbook of Social Security Disability Insurance (SSDI) and the early attempts at "schedules" in workers' compensation. The reliability and validity of this inference, however, leave much to be desired. The alternatives currently used include the "expert opinion," even when based on direct examination, which is heavily used in both programs. The opinion of the worker's personal physician is relied upon only before the administrative law judge in the SSDI program. These administrative alternatives color the doctor-patient relationship and the worker's perceptions of his illness.
在美国，残疾判定传统上基于经典的医学疾病范式：如果确定了疾病的量（病理解剖学异常），就可以预测疾病的程度（症状），包括疾病在工作场所的表现。这一推断是《社会保障残疾保险手册》（SSDI）以及工人赔偿领域早期“时间表”尝试的基础。然而，这一推断的可靠性和有效性却很不尽人意。目前使用的替代方法包括“专家意见”，即便其基于直接检查，这在两个项目中都被大量使用。在SSDI项目中，只有在行政法法官面前才会依赖工人私人医生的意见。这些行政替代方法影响了医患关系以及工人对自身疾病的认知。
