Dr. David B. Adams – Psychological Blog

Psychology of Illness, Pain, Anxiety and Depression

The Inability to Understand

I recommend, and routinely assess the intellectual functioning of injured workers. There are two problematic groups for which intelligence plays a major role:

a. Those injured workers of significantly subaverage intelligence not only may fail to understand their condition, treatment options and risk/benefit of surgery, but they may also lack the capacity to formulate questions to obtain the data they need. Post-surgically, they may complain about pain but be unable to have their fears/concerns assuaged by the explanations provided them and/or fail to understand their post-surgical treatment regimen (medication, physical therapies and objective limitations).

b. Those injured workers of significantly above average intelligence may find the del ays inherent in their care, the awaiting for approval of treatment, and the lack of extensive patient education to be frustrating if not threatening.

For those in the former group, it may take repeated and simplified information and instructions to maximize quality of care and compliance for the patient.

For those of above average intelligence, the workers_ compensation system, with its checks and balances, may feel demeaning or insulting. These patients may feel that their capacity to understand is dismissed and their intelligence impugned by a system that encourages passivity and dependency.

If you do not formally measure the capacity of the patient to understand the condition and treatment options, there is no established frame of reference with which to communicate on a level acceptable to the patient. Differences in intelligence levels can be as disruptive to communication as differences in spoken language.

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