Dr. David B. Adams – Psychological Blog

Psychology of Illness, Pain, Anxiety and Depression

Anticipating Depression

An injured worker has the right to expect that whomever he sees is competent and independent. The competent aspect appears self-evident, but many injured workers believe that employers and insurers use highly biased doctors. The old, but entrenched, term is “insurance company doctor.” Injured workers believe that their employer contracts with marginally competent and highly biased doctors.

When an employer/insurer can influence what a doctor says in a report, influence when a patient is returned to work, or even influence what care the patient receives, the injured worker’s worst suspicions are validated.

Here is a more insidious and concerning fear that injured workers carry: this biased doctor refers me to his partner and/or his friend without regard to others who may be more skilled and more objective. A frequent complaint of the injured worker is that he/she was referred to someone in the same office, same building or someone whom they have been led to believe has business or social ties to their treating doctor.

There are many treatments for which patients must be screened. Chief among them are the prescription of drugs like oxycontin or the implanting of a spinal column stimulator or morphine pump. Ideally, if a patient is shown to be a poor candidate for the narcotic or the implant, then alternate treatments will be used.

But who screens for these things? Can such screening be done by in-house staff? Can you objectively screen for something from which you will make money? Can you hire someone to perform the screening when you are the source of their income, and then ask them to objectively deny a procedure from which you (and indirectly they) make money? Screening was intended to be an external process.

Patients feel that this cannot be done. They wonder why they are referred to practice partners or close friends. They wonder why they are screened for a procedure by personnel in the same practice where a procedure will be performed.

I fear that we often disappoint those who come to us for care by behaving as though they cannot see the transparent flow of monies or the needs to please referral sources. And it is difficult, if not impossible, to reassure a patient that opinions made on their behalf are honest and objective.

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