In an ideal world, patients would tell us the truth and be motivated by nothing more than recovery and return to productivity.
In that ideal world, they would have healthy and supportive families, and the patient’s themselves would be relatively problem free and have occupational options. They would be without deep resentment, financial problems and would have understanding and supportive employers. They would have received timely, appropriate, effective and immediate care for their illness or injury. They would have good health habits, take medication as directed and not be influenced by the manipulations of others.
In the ideal world, patients would not be manipulative.
Clinically, I strongly believe that if a patient feels that his/her surgeon does not recognize or take into account their “other issues”, the patient sees the doctor as a tool for things other than treatment. It may be a tool to access medication or time-off or to increase the financial value of their litigation.
Yes, I do believe you are best served by attempting to see the patient for a biological, psychological and social vantage point (the biopsychosocial model). It is not difficult, and it can make care more specific and permit you to objectively determine when care is complete. The alternative is to be buffeted by forces which you fail to recognize but which, in fact, drive the course of treatment and its outcome.”