When a patient seems depressed or when the patient indicates he/she feels she needs assistance, that is the time to consider a psychological examination. Similarly, if the primary provider, a surgeon for example, feels that it is indicated, it should be pursued.
However, the point at which one need to consider a psychological examination is when the patient_s injury complaints have continued beyond that which the objective clinical findings would indicate. Thus, if 30-60-90+ days after injury, and current clinical findings indicate the patient should be capable of returning to work, but the patient continues to complain of symptoms and resist return to work, psychosocial factors are at play.
These psychosocial factors will not subside. They most often become entrenched and/or expand. While 2nd and 3rd opinions as well as more physical therapy and new medications are being sought, there may be no change in the patient_s willingness to mobilize.
This process can continue for months, if not years, and is not addressed until you determine what psychosocial factors are driving this resistance to recovery.
Ideally, this will be noted before the patient and others directly request psychological examination. Indeed, the patient may strongly resist such an examination due to fear of revealing and dealing with the true problems that are creating their resistance to recovery.