Category: Obstacles


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 …

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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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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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Alexithymia: “A patient and his wife were sitting in front of me. The issue was that he was physically abusing her, …
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Co-Morbid Patients who are taking prescribed narcotics for their chronic pain are exposed to a system in which the following …
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bad actors

Bad Actors

Bad actors: You do not have to be a nice person to be a police officer. You do not have to have self-insight, a good philosophy …
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