Dr. David B. Adams – Psychological Blog

Psychology of Illness, Pain, Anxiety and Depression


I question whether all injuries that are classified as catastrophic are always genuine about their physical and psychological status.

Unquestionably a very seriously injured individual with tragic permanent consequences to their injuries may need psychological support to deal with their limitations. However, increasingly, I am seeing patients who seek a catastrophic classification for purely financial purposes. Characteristic of these patients is failure to tell me that their authorized treating physician has released them, with restrictions, to return to work. Instead, they tell me that they are still in care, still seeing their physician and do not know when they are being released.

This is, again, an instance when it is mandatory that surgeon and psychologist coordinate efforts so that there is no confusion as to the patient_s status.

Allow me to provide you with an example: A woman seen this week had been injured at work, stated that she both wished to return to work but also wished to return to college. She stated that she was emotionally unable to tolerate a return to the setting where she was injured, and, as a result, had applied and been accepted to a nursing program at a local university.

She stated that she was supported in this decision by her surgeon who felt that she was not physically capable of returning to work. However, I was in receipt of a letter from the surgeon outlining his release of this patient, delineating her restrictions and stating that he not only felt she could, but that she must, return to the workforce.

The patient was attempting to play us against each other, knowing that her physical limitations were not severe and, consequently, wishing her psychological limitations to appear even more severe.

These situations are disheartening since time spent with manipulative patients is time away from sincere and suffering patients.

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