Category: Obstacles

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 …

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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 …

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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 …

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Reluctant

When a patient reaches MMI with a permanent and partial disability, s/he should be focusing on dealing with chronicity, not facing the reluctant clinician, hesitant to “let go”. There is an understandable resistance among patients to accept that their limitations and suffering may be chronic. But sometimes the treating clinician appears to have more difficulty …

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Fear of Re-injury

Fear: There are many factors that create alarm among injured workers, but the final concern may create the greatest psychological disability: a. there is no future employability b. disappointing to, and thereby being abandoned by, the family c. the incapacity to cope with the role of chronic residual pain d. fear of re-injury. Patient’s dread of re-injury creates …

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burn

Burn: I had a patient who was barely 21 at the time of his injury. He was shy, poorly educated and had never dated. He had …
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hateful

Hateful

Hateful patients: It has always been irrational to be forced to treat a patient who is either physically threatening or emotionally …
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divorce

Divorce

Divorce:  While the source of post-injury disharmony is most often financial, there are more insidious problems that arise …
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