I was honored in 2020 to be contacted by representatives of the American Medical Association. They introduced me to their plans for a new impairment guide paradigm which envisions transition to hosting the Guides online. In 2021, the first version of the "digital" guides became reality, and yet the work continued. The experience has been largely fascinating, but in one particular respect, quite disappointing. The disappointment is likely clear as the paragraph began with 2020, and so did the pandemic.
The disappointing part of my AMA Guides experience has been the inability to meet in person. I have come to some familiarity with many exceptional intellects over the last two years, but in a Zoom environment. Zoom is perhaps "the next best thing," which is frankly just another way of saying "not the best thing." I have attended many meetings, gained much knowledge and perspective; come to appreciate some different perspectives. However, I do not really feel connected to the physicians on the Editorial Panel.
Additionally, the AMA headquarters is in Chicago, and from a purely selfish perspective I have been lamenting the absence of Lou Malnati's, Gino's, and Labriola (in the old days I would have mentioned Giordano's and Pizzeria Uno, but those are both now Orlando staples). Despite its failings (frigid winters, etc.), it is tough to beat the pizza in Chicago. Perhaps 2022 will bring a long awaited gastronomical opportunity? More importantly, the chance to meet face to face with some of the very best in our medical community?
Opportunity. That is the critical word. Moments come and go. Some see opportunity and others not so much.
William Arthur Ward is credited with saying “opportunities are like sunrises. If you wait too long, you miss them.” I like that one, and there is a plethora of quotes out there about opportunities. They are “disguised as hard work,” and “neglected,” and “expensive.” Perhaps all true. However, my favorite is that there is no such thing as a lost opportunity. Andy Rooney is credited with that one: “opportunities are never lost; someone will take the ones you miss.” See, there are impacts from opportunities.
And, today opportunity knocks. Not the opportunity to criticize impairment proxies generally, or the challenges of medicine in the world of workers' compensation. There are challenges in these systems, and we acknowledge and accept them. That workers' compensation is a human endeavor dictates that it will be replete in both design and execution with human failures. Despite that, we struggle on. Despite our admissions that there will always be challenges, a small minority of professionals from various disciplines persistently struggles to make workers' compensation better in various ways. We are an intrepid band to be sure.
The entire effort of the AMA Guides Editorial Panel is in that spirit. My experience with them has been exceptional and overall (see above re pizza) positive. They are focused and dedicated, but I sense they harbor no illusions of Building the Perfect Beast (Don Henley, 1984). In that refrain, Henley notes:
"Ever since we crawled out of the ocean and stood upright on landThere are some things that we just don't understand"
Despite that, he notes that nonetheless
"We're shakin' up those building blocks"Going deeper into that box- (Pandora wouldn't like it)"
Collectively we are, in short, striving to build a better beast. The AMA Guides Editorial Panel is a prime example of that effort. It is persistently questioning what is in the Guides, the foundations, the conclusions, the processes, and more. We are now in a moment of opportunity. Beginning June 1, 2022, the Panel is seeking your input, guidance, comment, and even criticism. This is your opportunity ("Never send to know for whom the bell tolls; it tolls for thee"; John Donne). That piece by Donne is also a great reminder that we bring great strength together.
On June 1, 2022 a public comment period opens for the proposed updates to the AMA Guides. The projected adoption of these amendments is January 1, 2023. There are changes currently proposed regarding the spine, upper extremity, and ear nose and throat. The time period will extend for about 45 days, and conclude July 15, 2022. It is an opportunity to speak your mind, which in itself is not that uncommon.
However, this opportunity is uncommon in that you may speak your mind before the amendments are finalized. Rather than playing Monday-morning quarterback regarding these changes, you have the opportunity to participate in the changes, to help pick the play perhaps. You have the chance to speak your mind, engage the incredible collective intellect and capacity of the Editorial Panel, and possibly influence the direction and detail of this critical element of workers' compensation.
Or, as Andy Rooney suggests, you may forego the opportunity and let someone else have it. You can let your expertise and intellect idle on the sideline while someone else expresses perspective and preference. You can forego and forebear while others "dig deeper into that box" and build a better beast. They can and will express their opinions and make their choices. But, whether to express yours is entirely up to you alone. You alone can choose to sit on the bench or get into the game.
The AMA is making an unprecedented effort at transparency. For example, each of those Zoom meetings I have attended has been open to the public, and is available for your review. The questions and comments of the public have been invited, encouraged, and considered. The process has been open, gracious, and welcoming. Now, in the next stage, the public can express thoughts. Will you?
The details are on the AMA website:
You owe it to yourself to consider the proposals. You owe it to this community to express your thoughts. If nothing else, perhaps you could acknowledge and appreciate the extraordinary efforts at transparency and openness?
