An injured worker has a perfectly normal MRI but has been telling others that he has _a ruptured disc,_ and he makes interim appointments with his orthopedist and now wants a consultation with a neurosurgeon.
The first thing to check is whether his doctor is talking to him or if the patient is seen by a physician_s assistant and/or a nurse practitioner. That is, does the patient feel that he/she has the attention and investment of his doctor.
Many injured workers report that little time is spent with them, that their chart is not reviewed before (or even when) they are seen. They are referred for physical therapy or prescribed medication without what the patient feels is a reasonable physical exam. If they become frustrated, they are called non compliant. If they do not improve, they called unmotivated. If they say that they are depressed, this complaint is often not even reported.
Why does this arise? When a patient has complaints that exceed initial objective findings, they immediately become a target of suspicion. Yet these suspicions are rarely discussed with the patient (_we need to find out why you have these complaints when the test results do not support them._) Instead, the discrepancy is reported to everyone but the patient. When the patient is finally told, it is often in the form of _there_s nothing more I can do for you_(or worse)_ _I do not know what you expect me to do for you._
Thus, one of the first considerations when a patient_s complaints (most often pain) exceed objective findings, be certain that problems in the doctor-patient relationship have been addressed._