PHYSICIAN'S EXPERTISE OF WORKING CAPACITY
Author: Boris Martzinkovski
When I first tried to inquire into the problem at hand and I was put in front of a blunder. This issue has been a kernel in the socialist health care for a long time and huge mass of literature was compiled for a period of 70 /seventy/ years. The problem appeared to be quite difficult to systematize and besides the difficulties were twofold. From the one hand, a western expert could find only a pile of non-comparable information, which, could instigate his research with no more than panic. On the other hand, an eastern expert would engage in some kind of quality research, unless, enough money is invested in the project. Now, we reach here to a middle way and it leads to nowhere. I know this from my personal experience. My dissertation has been reviewed from a panel of independent experts and it comes to enter its fifth year of duration. Being experts from both sides of the wall and they couldn't reach consensus for so long time on such a trifle question. I wonder, what, is going to happen if an issue was of international importance, really!
Whatever, we shall try to present some key points on the research concerned with working capacity and disability. As we said, since we find difficulty in making a start and a decision was reached to consult a Russian secondary source. Subsequently, we have here a translation book and written in the early 50s by B. Martzinkovski - a russian expert, who, based his research mainly on the bulk of "Bolshaya Medizinskaya Entziklopediya" /i.e., transliteration is from russian/. We refer, here, to the "magnum opus" in the russian medical literature and encompassing 36 /thirty six/ volumes with 2 /two/ indexes - which, in its third circulation was edited by V. Bakulev. This encyclopedia, in the interim, contains wealth of information on different issues and since we don't have a comparable work in our libraries in some other language - namely, it has become a medical bible for a whole generation of medical specialists.
Enough, making excursions in history is one thing, while, translating back an information is quite another. For the value of our presentation and we came to a couple of interesting conclusions:
First, most of the terminology used on the issue is of German origin - namely, terms like "Arbeitsfähigkeit" and "Erwerbsfähigkeit" comes to denote, respectively, work capacity /i.e., in a biological sense/ and labor capacity /i.e., in a social sense/. These are interchangeable, but, sometimes have different connotations when making comparisons from medical or economical point of view;
Second, when it comes to parameter estimation and English terminology is used - namely, terms like "new claims", "days lost" and "spells commencing" comes to denote, respectively, a multitude of parameters used to measure absence due to sickness. In bulgarian, these sounds like "chestota na sluchaite", "chestota na dnite" and "sredna prodalzhitelnost na sluchaite" /i.e., transliteration is from bulgarian/ and a wealth of statistics is available with such parameters. The other question is, whether, such statistics is reliable and methodologically sound;
Third, on an international agenda and we have terminology used by WHO /World Health Organization/ - namely, terms like "impairment", "disability" and "handicap" comes to denote, respectively, a focus on the level of prevention with emphasis on causative factors, diagnostics and rehabilitations. These are solutions in the domain of "primary prevention", "secondary prevention" and "tertiary prevention", while, a wide range of topics are clarified in the "International classification of impairments, disabilities and handicaps: a manual of classification relating to the consequences of disease" from WHO, in many editions.
We hope, that, our small contribution will be of some help to future research in the area. Since, the scarcity of materials on that particular topic and we intend to make further inquires on titles from our booklist.
Figure 1: Sample formulary for temporary incapacity /in bulgarian/.
(i). These list-blanks were used as voids for working expertise in LKK and TELK commissions /i.e., transliteration is from bulgarian/ from as early as 1948 /nineteen forty-eight/ in Bulgaria.
Copyright © 2005 by the author.