All of the controversy surrounding Functional Limitation Reporting somehow reminded me of a charming 104 year old patient that I had the privilege of treating years ago. I saw her once a week because she was having shoulder pain. She had shoulder pain because she fell out of a cherry tree when she was a sprightly 94 year old, so she had some boney callus at the surgical neck of her humerus and some impingement. So, her biggest medical problem at that time at 104 years old was her right shoulder pain.
Functional Limitation Reporting brought her back into my memory, because she just had pain. Period. No real functional impairments. What would you expect a 104 year old lady to be able to do with her right arm? I think her days of doing heavy housework or throwing curveballs were over. If I were seeing her today, I guess I would have to either work hard to figure out how my treatment was going to help her function, or I would have to use the Other category.
But she also brought to mind some of the silliness of the impairment ratings. Let me explain: She had no short term memory and she was also very proud of her age. So, at every weekly visit, she would ask me to guess her age, because she had forgotten that she asked me the same question the prior week. The conversation always went something like: “Do you know old I am?” followed by me telling a white lie and saying “No, how old are you?”. She would invariably draw herself up to her full 4 foot 8 inches and in her strongest, proudest quavery voice say “I am a hundred and four years old!” I would feign shock and say “You don’t look a day over 99 to me!”. Then she would laugh. The beauty of this was that we could relive the same joke together every week. It was just as funny to her every time.
The point of my story is that guessing a 104 year old woman’s age reminds me a lot of the Impairment Ratings. There is really not a lot of difference in a 99 year old and a 104 year old. They are both very old. Is there really a difference between that 75% impairment (CL Modifier) and 80% impairment (CM Modifier)?
I don’t think so.