Category: Obstacles


Compliance: His wife called and said that he has been very depressed. So we scheduled him for an appointment. He has failed to show for almost all appointments. A spouse may be more aware of a change in mood than the authorized treating physician. Because a wife feels her husband is depressed is not sufficient to …

Read more


Damages: It would be a ideal if psychological recovery coincided with physical recovery. Quite often, it does not. The depressive symptoms begin over time as the patient begins to cope with pain, limitations and the impact upon career and family. The surgeon will ultimately have completed his/her work on the patient and will release the …

Read more

Fear of Re-injury

Re-Injury: A person who cannot tolerate a return to the environment in which a injury/trauam occurred can be suffering from PTSD. However, there are a variety of valid reasons why an injured worker cannot, and perhaps should not, return to the environment in which he./she was injured. Re-injury: Here are several valid concerns related to …

Read more

Goal Gradient

The Goal Gradient: Importantly, those who determine functional capacity, maximum medical improvement and/or permanent and partial disability, quite often have no understanding of the patient’s life either before or after settlement. The “goal gradient” is a concept from psychological learning theory in which our behavior increases the closer we get to a goal (settlement). An …

Read more

Going Both Ways

“Going Both Ways” I have often discussed the impact of delayed care and procedure approval on injured workers. They believe that there is no clinical basis for those delays and that the denied or postponed authorization is solely for cost containment. Sometimes they are correct. There are times, however, where the delays arise because a …

Read more



Hypervigilance is a symptom. Vigilance is the ability to stay focused upon a task and/or concept for an extended period of …
Read Blog Post



Contradiction “We read two of your consultation reports last month.  One said that the patient lost 20 pounds which was …
Read Blog Post



Generalized Anxiety Anxiety is a milder form of fear, and as you know, fear is an essential emotion that protects us from …
Read Blog Post