Dr. David B. Adams – Psychological Blog

Psychology of Illness, Pain, Anxiety and Depression

A Case in Point

This is a 31 year old male who sustained a neck injury when falling from a hyster.

The MRI did not confirm his symptoms. The adjuster should have requested an immediate psychological consult before the case worsened. This was the second week on injury.

The adjuster did not request a psychological consult. The surgeon several months later recommended a psychological consult, and the adjuster refused.

Concurrently, she sent the claimant_s checks late, was rude to him on the telephone and openly told others that _he is faking, and I do not like him._

Still no psychological consult approved by her.

More and more surgeons became involved, and the patient clings to the belief that he needs an anterior cervical disc fusion.

The injury is now 15 months old. With great difficulty, the adjuster finally relented, and the patient was seen in psychological evaluation.

It was determined that he has an IQ of 85 (he is in the lower 16th percentile of intelligence). He quit school in the 7th grade at 16 years of age. He has never had a career; always done temporary manual labor.

His family, including his wife and children, are in Oklahoma to which he desperately feels he must return since he knows his wife is being unfaithful. He cannot send child support ($175 per week) while on workers_ compensation ($225 per week). He has nowhere to live.

He misunderstood one surgeon who recommended epidurals and believed that to mean _a fusion_ which he feels is being deliberately withheld. He refers to his bulged cervical disc as a _broken neck_ and believes that he will awaken on morning paralyzed.

Prior to the psychological consult, no one was aware of these issues in his life.

The resolution has been clear since the first week of injury:
a. He needs (and now will receive) a very simple and direct explanation of his problems.
b. He will be provided with a PPD rating (which is actually quite low)
c. He will be explained the concept and appropriateness of MMI release
d. He will offered a settlement so that he can return to Oklahoma

This was a _simple_ case which was not managed appropriately and extended for a year longer than necessary. Unfortunately, this is also common.

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