Dr. David B. Adams – Psychological Blog

Psychology of Illness, Pain, Anxiety and Depression

Patient Expectations

If a patient had refused to attempt a return to work even though the employer has a position within the patient’s restrictions, I would be concerned about some degree of malingering.

However, just because the employer says that there is transitional work available within the treating doctors restrictions does not mean that the employer is accurately describing what is being offered.

Too many times, I hear of a patient return to work with specific bending, lifting, standing and sitting limitations. The patient arrives at work and within hours, he/she is being asked to do work exceeding their limitations. Quite often they are then asked to do the very work they were doing when injured.

The patient becomes fearful, then angered and then depressed and refuses to return. The employer reports only part of the story.

For one automotive manufacturer, patients with limitations are placed in a large group in a day room. There they can read, watch TV, play games or just nap and chat. It is boring, unfulfilling and demeaning. In such a setting, some patients become more depressed than when attempting to do work that exacerbated pain.

Any time that a patient declines transitional or light duty, some attempt should be made to determine what interaction occurred with management when he/she attempted a return to work. Determine what was specifically said to the patient, and determine if their were covert threats of consequences should he/she not comply.

Injured workers can be manipulative, but so can employers, especially those who have staff limitations and production quotas.

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