Do you order a psychological exam when the patient seems depressed or when the patient requests it or when the primary provider thinks it is needed_?
Those are not the ideal times.
Obviously, if the patient seems depressed to you or when the patient indicates he/she feels she needs assistance, you would investigate that need and refer accordingly. Similarly, if the primary provider, a surgeon for example, feels that it is indicated, it should be pursued.
However, the point at which *you* 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 you continue to authorize 2nd and 3rd opinions as well as more physical therapy and new medications, 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.
You may realize that this is occurring long 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.