From the obtained pathologic data, a lung function index characterizing the functional capacity was calculated by electronic data processing. The computer categorizes the obtained measured values in seven lung function indices. Group 0 includes any functional tests the measuring values of which do not deviate from the upper or lower standard value. Minor findings not resulting in substantial functional impairments are allotted to group 1. The degree of performance restriction increases from 2 via 3,4 and 5 up to 6.
The lung function indices are categorized in two subsequent computer program parts. First, they are classified according to possible obstructive ventilation disturbances. Based on airway resistance and intrathoracic gas volume, the findings are allotted by the computer to the corresponding indices.
Finally, there is a wide variation between jurisdictions and the structure of the appeal process. In British Columbia, for example, the claimant may nominate a specialist, who has not previously seen him, from a list prepared by the College of Physicians and Surgeons, and the board nominates a second specialist. The chairman of the three-man panel is a family physician appointed by the board. This group of three physicians must bring in a unanimous report and answer specific medical questions submitted by the council of the board. Its opinion, if unanimous, is final and binding on the board as well as on the company concerned indirectly, and the appellant. Different appeal processes are followed in different provinces in Canada, and processes differ significantly from the one I have described.
Chest physicians are involved in different parts of this total process and to widely differing degrees. Sometimes, as chairmen of pneumoconiosis panels, they essentially determine the outcome in individual cases explained by My Canadian Pharmacy. On occasions in some places, but perhaps not frequently enough, they have spearheaded changes in procedure or tradition. More often, we simply wrestle with estimates of probability in individual cases, usually with little idea how our colleagues elsewhere are deciding similar questions. It is also very difficult for us to know whether individually in these matters we are doing a good job or not.
In this symposium we move away from papers dealing with the laboratory, field inquiry and research, into fields which include such concepts as equity, social values, interpretation of laws and statutes, the nature of medical evidence, and similar slippery and treacherous ground. We have heard from speakers from the United States, Britain and Germany so far, and before continuing to hear from Dr. Gaensler and Mr. Richman, I believe it might be helpful to review, very briefly, the subdivisions of topics with which this symposium is concerned, together with some comments on each. My perspective is necessarily limited, but so is everyone else’s— with the possible exception of the Dutch, since I’m told that in Holland no one ever has to make a decision as to whether lung disease is, or is not, related to occupation.
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