Dr. David B. Adams – Psychological Blog

Psychology of Illness, Pain, Anxiety and Depression

Can of Worms

The concern is often expressed that a psychological exam, performed on an injured worker runs the risk of revealing problems that ordinarily not be address. In fact, the impact of a psychological exam is the opposite of what one would anticipate. It does not expand the scope of a complaint; it focuses it upon the real underlying issues.

Psychological factors driving a _case_ are going to be operational whether they are revealed by examination or whether these factors blind-side you and emerge when the health care team is least prepared. Ignoring them does not make them less of an issue.

The _can of worms_ that is opened during exhaustive psychodiagnostic examination is not problematic for the employer/insurer/nurse-case-manager, but it may be problematic for the patient.

Most often there are factors (addiction, martial problems, legal conflicts, financial difficulties, etc) that are the true cause of why a patient elects to remain in the patient role.

Once others become aware of these factors, the patient is required to address them and accept them as unrelated to injury.

The patient does not want to address such issues, and/or the patient is fearful that he/she is incompetent to address them.

Thus, the psychological data revealed in examination are issues that clarify, not complicate, case management.

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