On the difficulties of disability and its determination

The World Health Organization (WHO) model for the cascade of disease to impairment to disability to handicap does not adequately model pain and psychological dysfunction. The work disability of the legal system comprises WHO disability and handicap. But the physician usually cannot determine handicap. The process by which work disability is determined, imposing a judgment role on the physician, compromises the physician-patient relationship and the physician's primary responsibility: enablement of the patient. Physicians should report patient data, but ordinarily should not judge work disability.