Dr. David B. Adams – Psychological Blog

Psychology of Illness, Pain, Anxiety and Depression

Distrust and Revenge

Cases sometimes “turn psychological” after all physical complaints are resolving, and the requirement is that the patient return to work. The patient now, and for the first time, states that he/she is depressed.

Let’s first separate out those whose pain and limitations are valid, and they feel they are emotionally unable to work, will be fired if the return, or are are bound to re-injure themselves.

That leaves us a group, and I agree that it is not a small group, of those who are encouraged by others to milk the system with this seemingly intangible disorder called depression.

I recall a patient whose attorney called the office stating that his hand injured client was now “psychotically depressed” because he had just beat his wife, was carrying a gun and tearing up doctor’s offices.

The reality is that he had just received word that his “settlement” offer was about 10% of what the attorney had led him to anticipate. He was, therefore, trying for a hospitalization and a whole new level of disability determination. It failed, but the attempts are not uncommon.

I also have noted several times that while someone may want a patient to feign depression, a patient rarely does this very well. They have things to do, places to go, and people to meet. They do not have time to lay around with the shades drawn and lose a lot of weight. Instead, they are often engaged in many physical activities far beyond their claimed limitations and having a grand time socially engaged with friends.

These bogus claims are not likely to ever cease. The most effective means of case management is gathering as much objective data about the patient as feasible. If the patient is depressed, there will be a consistent clinical picture. Where that consistency is not found, the depression is not a valid claim.

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