Dr. David B. Adams – Psychological Blog

Psychology of Illness, Pain, Anxiety and Depression

Clinical versus Administrative Decisions

Clinical Decisions:

There are injured workers who appear to languish in care moving from orthopedic care to pain management to psychological care with no end in sight. The concern is whether we are serving these patients when we tie these significant problems to an injury.

The problem can arrise when the clinical problem has been diagnosed and appropriately treated, but a treating clinician feels uncomfortable simply releasing the patient and, therefore, feels that there is always _one more_ referral that needs to be made.

But there is a more compelling problem and that is administrative. The patient may believe that he must be out of work for a specific period for their injury to _be worth_ a specific sum of money.

My experience has been that after a case is ~12-18 months old, a patient readily acclimates to nonproductivity, and the focus of his attention becomes financial as the physical recovery appears more elusive.

It is important to identify the patient’s goals rather than merely our own. The patient may need to be redirected to examine specific concepts of productivity or, in some case, accept that occupational productivity may no longer be viable for him/her.

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