I have been working an extra job lately on some Saturdays, performing physical exams for a company that contracts to the state disability determination services. Clients apply for disability, get an interview with an intake person, supply various supporting documents, and then get scheduled for a physical exam. I receive electronic records ahead of time, whatever the state has received to date, and I am given 30 minutes to talk to the client and examine them. After a very full day of appointments (last Saturday I saw 15 clients) I dictate a report on each client. My instructions are to "provide a complete history and physical" to the people who take it from here. The next steppers will review all the records, including my report, and make a decision about whether the client is disabled and, if so, how disabled.
Thankfully, the final decision is not mine. It's hard enough making some kind of statement about how each "allegation" (the official term for the medical condition that is affecting the client or claimant) impacts the health and functionality of the client. Many cases involve pain, which is very hard to objectively document.
Naturally, I can't mention specific cases here, at least not in enough detail to be able to identify anyone. I have already seen a huge variety of medical problems, from amputations to aneurysms, back pain (lots of that) to bipolar disorder. Plenty of suffering. Everyone suffers. But are they suffering enough? Enough to get a government handout? If a man has been a plumber all his life, and can no longer crawl and kneel, what should he do? Should he be required to learn a new skill after all these years? Should he kick back and live on disability payments? What about the young person who has years of productive life ahead of them? Should a car crash that leaves them with occasional or even frequent back pain ground them for life?
I don't know the answers. I do know that some of the people I examine seem very disabled, and some don't. Are there scammers in the lot? Probably. There are also frustrated hardworking people, embarrassed at their unintended impotence and wishing they were back on the job this minute. There are also bewildered disenfranchised folks without health insurance who are hoping to access health care through this particular back door into the system.
No doubt I'll have more to say on the subject with time. I'm learning a ton.