Dr. David B. Adams – Psychological Blog

Psychology of Injury, Pain, Anxiety and Depression

Can of Worms – Revisited

Nurses often seek psychological referrals to determine why claimants are not improving, not returning to work, but ckaims adjustors will otten not order a psych. exam., afraid that it would open them up to additional costs.

If the claimant is not working, continuing to access health care, charging you for medication, doctor visits, repeat MRIs, course-after-course of physical therapy, pain management_look at your current expenditures as nonproductive_and what are you saving?

It sounds like the big concern is that a psychological exam is guaranteed to indicate the need for psychological care and that such care will go on endlessly. In reality, less than 5% of those psychologically examined would ever consider being in psychological care (social embarrassment) and of those few, most will terminate care very rapidly. For those who do seek and continue in care, you set a strict limit as to number of visits.

A psychological exam does not reveal any problem for which insurers are not already paying. You may be paying for pain that does not exist, for limitations that are exaggerated, for lack of ambition, lack of motivation, fear of failure, few occupational skills and options. And you are paying for these because they are presented to you as physical complaints.

Underlying problems govern all cases. The patient does not want to reveal or address these issues. So they direct attention at physical complaints.

In turn, you try to _solve_ their psychological problems by meeting their physical needs; then become discouraged when that is not effective.

The can of worms exists whether you deal with it or attempt to keep a lid on it.

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