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May 26, 1989

School and Work Release Evaluations-Reply

Author Affiliations

Baylor College of Medicine Houston, Tex

Baylor College of Medicine Houston, Tex

JAMA. 1989;261(20):2955. doi:10.1001/jama.1989.03420200044024

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In Reply.—  We thank Dr Wishart for raising the important question of whether our conclusion—that primary care physicians should play a lesser role in the evaluation of short-term absences—could be extended to long-term absences by subspecialists. Although our article focuses on the primary care setting, we agree with Dr Wishart's assertion that work release and disability evaluations create problems for subspecialists too. Recently, a hand surgeon wrote to us complaining that "probably 70 percent of my practice is Workman's Comp and the other 30 percent is probably third-party liability claims."We agree that psychological factors and notions of illness and healing can figure significantly in a person's understanding of her or his ability to work. Our article could have given more attention to this aspect of the absenteeism problem. Even so, structural factors such as absenteeism policies, job satisfaction, and employer-employee relations often influence a person's understanding of the disability