The Fetish of the Objective Finding

Abstract

Pressure is mounting for clinicians to rely solely on “objective” measures when evaluating workers with possible work-related disease. These measures are intended to largely supplant the worker's history as sources of information regarding diagnosis, work relatedness, and extent of disability. While seeming to promote more accurate and neutral evaluation methods, the underlying agenda is to reduce business costs by denying work-related illness and disability. Promoting the view of occupational health as the province of technical experts, the campaign for the “objective” finding silences workers as unqualified to comment. The methods proposed to enhance objectivity also suffer from significant specific shortcomings. To resist efforts to fetishize the objective finding, clinicians need to recognize the subjective elements of objective methods as well as the objective value of subjective data. This requires recognition of the central role of workers and histories in the clinical evaluation process.