I shall always be rather amazed that prior to my seeing a patient, no one, even if the patient is already in psychological care, has obtained a complete history on these injured workers.
It appears that everyone proceeds from what the patient says is wrong with them, rather than attempting to determine if there may not be multiple other causes or contributors to their complaints.
As you know, a negative MRI or CT scan (etc) will not stop a patient from complaining. So we need to know what the source of these complaints.
I recently saw an injured worker who had been in psychological care for two years at the request of her orthopedist. During my IME of her, she objected to my obtaining a past developmental and health history. Her foundation: _no one else ever had._
Yet, she has prior unreported MVA_s and lawsuits, prior problems with addiction, disabled parents and sister, and had been abused as a child, been a repeated and recent victim of domestic violence, and was receiving as much on disability as she had when she was working. And_she had only been in the workforce for three years, had five jobs during that time, was about to remarry and did not want to ever return to work.
She did not need psychological care for her injury; it was indicated for her numerous past problems.
Until a truly thorough history is obtained, care cannot be targeted solely to the injury.