Dr. David B. Adams – Psychological Blog

Psychology of Illness, Pain, Anxiety and Depression

The Insurance Company Doctor

Failure to show for an appointment, or to comply with a treatment regimen, is not a benign behavior. It does not occur by accident. It always has implications.

Let’s look at a few examples:

1. The patient states that he/she is depressed due to pain, needs to be immediately seen, and then fails to show because travel monies were not sent. While it could well be that the individual is so financially strapped that he/she cannot afford gasoline, this behavior is more often a passive-aggressive expression of bitterness and resentment.

2. The patient tells the treating physician that he/she is depressed and needs to see someone. The appointment is immediately made on behalf of the patient who then fails to show because there was not sufficient “notice”. Has the depression taken a holiday until proper notice is given?

3. The patient has been in psychological care, and there is reason to be concerned that such care is unrelated to the work injury. A second opinion is scheduled for which the patient fails to show using either of the aforementioned excuses. Does this not add weight to the concern that current treatment is not injury-related?

4. The patient states that he/she is depressed secondary to injury-related pain and states that psychological care is desperately needed. The patient then fails to show, stating that he/she is in pain and did not sleep well the night before the appointment and is too tired to show for the appointment.

While these non-compliant behaviors can and do occur with private patients, they are quite uncommon. Private patients may want, but still avoid, care for purely emotional reasons.

Injured workers, however, invariably carry complex agenda that result in their attempting to orchestrate their own care so as not to adversely impact some anticipated financial outcome.

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