Luck J V, Beardmore T D, Kaufman R
Clin Orthop Relat Res. 1987 Aug(221):59-67.
During the working years, rheumatic conditions are the foremost cause of disability in the United States. Disability evaluation for Social Security applicants and Workers' Compensation patients is commonplace in orthopedic practices. Yet, formal education in this aspect of patient care is rare both during and after residency. Because of a lack of understanding and sophistication the physician who knows the patient better than any other evaluator often play a minor role in the determination of disability. Disability Evaluation Under Social Security--A Handbook for Physicians lists the medical criteria necessary for qualification. Severely disabled arthritis patients will not always fit into these various categories and may have to be considered under the rule of medical equivalency. Workers' Compensation statutes vary somewhat from state to state but generally include disability criteria. Familiarity with these criteria and the process involved will allow the orthopedist to communicate more meaningfully with administrators and will reduce much of the frustration and some of the cost inherent in this system. When subjective complaint (illness) is in excess of apparent organic pathology (disease), team evaluation under the direction of the treating physician will help sort out the dilemma and develop a treatment plan. One hopes that this will bring the illness more in line with the disease, and thus reduce the disability.
在工作年龄段，风湿性疾病是美国致残的首要原因。对社会保障申请人和工伤赔偿患者进行残疾评估在骨科医疗实践中很常见。然而，在住院医师培训期间及之后，在患者护理这方面的正规教育却很少见。由于缺乏理解和专业知识，比起其他任何评估者都更了解患者的医生在残疾评定中往往只起次要作用。《社会保障残疾评估——医生手册》列出了资格认定所需的医学标准。严重残疾的关节炎患者并不总是符合这些不同的类别，可能必须根据医学等效原则来考虑。工伤赔偿法规因州而异，但一般都包括残疾标准。熟悉这些标准及相关流程将使骨科医生能够与管理人员进行更有意义的沟通，并减少该系统中固有的许多挫折感和部分成本。当主观主诉（疾病）超过明显的器质性病变（病症）时，在主治医生的指导下进行团队评估将有助于解决这一困境并制定治疗方案。人们希望这能使疾病更符合病症，从而减少残疾。
