Dr. David B. Adams – Psychological Blog

Psychology of Illness, Pain, Anxiety and Depression

Worker Incompetence

Falsely believing that you can manage a case by knowing the nature of the injury is the single greatest error in case management.

That is what happens with people new to case management. They think `oh, this is a back strain..we_ll send the injured worker to Dr. X_and things will be fine._

In reality, Dr. X will obtain the appropriate tests, prescribe medication and P.T. and have the patient check back in a few weeks. His nurse will then ask the patient, at each visit, if there has been any improvement. They will adjust medication, continue P.T. and/or recommend more diagnostic studies based solely upon a combination of pain complaints and test results.

Many months will pass. The patient will be released to full duty or transitional duty with restrictions.

If the patient does not comply, and/or symptoms actually increase at the point of release, everyone is stunned. No one was prepared, and at that point, no one knows what to do except to force the patient to comply.

What is needed is for someone to ask the patient:
* What do you feel is wrong with your back?
* What impact has this injury had at home?
* Do you feel you will ever work again?
* Are you drinking to deal with your pain and fears?
* Are you sleeping much of the day?
* Do you get any exercise, or do you watch TV all day?
* Do you feel your primary doctor knows what is wrong with you?
* What do you feel needs to be done?

This will tell you much more than yet another negative MRI.

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