After a lumbar fusion on a patient who had been briefly employed for his company, the patient was initially deeply appreciative of the surgeon....perhaps overly appreciative. Then, following surgery, he became suddenly and abruptly hostile, demanding, and began drug seeking, making accusations of malpractice and asked for a change of provider to a questionable surgeon. Dr. Adams Replies: There is a disorder upon which we have previously touched. It presents itself as follows: a. More common among injured workers than the general public b. Characterized by an unstable sense of identity illustrated by frequent and sometimes radical changes in occupation c. Accompanied by intense-unstable relationships and often frequent divorces d. A history of reckless acts varying from shoplifting to DUI, spousal abuse, and impulsive spending while already in debt e. Common pattern of substance abuse ...
We often see husband direct the course of care and obstruct any meaningful progress for the injured wife. Equally as often, we see the wife over nurturing this big and robust husband whose injury is modest but who loves all the attention. I strictly enforce the policy that the spouse is not permitted in the room while I am examining the injured worker. It is very, very common for the patient then to reveal the role that the husband (or wife) is playing in the injury. For a psychological exam, it can be revealing as to whether: the patient comes alone or the spouse sits for six+ hours in the waiting room and/or the spouse keeps asking staff questions the spouse makes unrealistic demands on breaks the spouse interrogates the patient the spouse wants to offer data about doctors, insurers, case managers, etc the spouse dispenses medication ...
Psychological care has always carried a stigma for lower socioeconomic classes, implying that only those who are weak would require such care. Common question of an injured worker: “Was you father ever depressed?” Answer: “No, he was a strong man.” Psychological care in relation to injury should occur every two to three weeks to avoid development of emotional dependency. Psychological care in groups is often a decidedly poor idea since patients in pain merely share their misery without sharing their solutions (which occur after settlement). Patients carry much emotional baggage into an accident. They may then seek to use injury related psychological care for non-injury agenda such as their marriage, children, and extended family problems as well as their criminal past, addictions, and then a host of phobias, sexual, and financial problems. Also, once in psychological care, some patients attempt to feign or amplify emotional symptoms feeling ...
Let me summarize an article by Dr. Stephen G. Gelfand, rheumatologist. It is lengthy but very well worth taking time to read this summary: “A serious medical and social problem today is under intense media, law enforcement, and regulatory scrutiny: the misuse and abuse of OxyContin (oxycodone) for chronic nonmalignant pain… In addition to recent Drug Enforcement Agency (DEA) autopsy findings of nearly 300 OxyContin overdose deaths nationally since January 2000, a large volume of patients with chronic nonmalignant pain have become dependent or addicted as a result of legitimate prescriptions written for OxyContin, as well as other opioids… In a recent case, the DEA suspended physician narcotic licenses and closed a South Carolina pain clinic for the excessive prescribing of OxyContin, although the physicians involved believed they were following current established standards… How did this situation occur? In the first place, certain …narcotic ...
3 Related Questions: 1. From a claims adjustor: “A surgeon has put one of our claimants on Elavil. Do anti-depressants help the injured worker, and how much of this depression are we stuck with?” 2. From a physical therapist: “One of my clients is tearful in every physical therapy visit, and when I asked him if he were depressed, he said that he was…I think he needs medication.” 3. From a nurse case manager: “How do I differentiate between injury as a cause of depression and all the craziness that is going on in this patient’s personal life?” First and foremost: is the patient truly depressed? And has this been validated with diagnostic testing or simply assumed based upon the patient’s (or someone else’s) statements. Unless clinically validated using recognized diagnostic testing, then all we have is a subjective impression that the patient “might” be depressed. He/She could just as easily ...
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