For many patients, the question can be stated: “If I cannot get a whole lot better…and I really do not know what to do with my life…what possible advantage is there in seeing or presenting myself as maximally medically improved.”
And for some of these patients, they may be quite correct.
After all, with the absence of education, absence of a viable (or appealing) future employment, what is the gain in the process of recovery to setting aside disability income, whether that comes from workers’ compensation and/or from social security?
For these individuals, the relinquishing of the patient-role (recovery) involves a net gain of zero. They have essentially nothing to gain by the process of recovery.
They may lack the skills and training that would enable them employment options. They may have investigated the salary levels of the jobs they could now secure and have decided that their current disability income provides more for them…and requires much less from them.
When looking at a case in which the patient “should have” reached MMI and now be returning to productivity, it may be past time to investigate whether the resistance to mobilizing might be arising from the patient’s erroneous
perception that there is no gain in returning to work. Then they must be assisted in seeing that their future, devoid of goals and objectives, will have little purpose or meaning for them.