Dr. David B. Adams – Psychological Blog

Psychology of Illness, Pain, Anxiety and Depression

Defining the Limits of Care

There are two types of “inadequate” psychological examinations:
a. Biased
b. Incompetent

And most bad exams are a combination of both.

Biased and incompetent exams can often, but not always, be determined by noting who made the referral. Does the referral source stand somehow to gain from the patient being diagnosed with an injury-related disorder?

The report will not be clinical and objective. It will be emotional. The biased exam has reference to the injury as being “horrible,” “miserable,” “traumatic” and references to how the injury has “destroyed” the patient. It will appear as though the patient has no role or capacity to manage this injury due to its horrific nature. The report often contains many subjective references to how the patient has suffered, how “terrible” it has been for patient and family, and may make reference to how he/she has been mistreated by those caring or financially responsible for the patient.

The patient’s history will be painted as remarkably free of any past psychological events. There will be no reference to past drug/alcohol addiction, past recovery for other injuries, past legal entanglements or even an accurate description of the patients development.

Past medical history will be sorely lacking. There will be minimal reference to the patient’s health behaviors; diet, exercise, obesity, nicotine, or caffeine. There may be no reference to complicating health problems such as diabetes, hypertension and respiratory problems.

There often is no reference to how much medication the patient receives, takes or seeks.

The report of the examination, and the patient’s life, will appear as though it began on the date of the injury. Divorces, loss of jobs, goals/ambitions, relationships with parents, sibs, in-laws and friends, will not be found.

There will be references to how sincere and honest the patient was and how he/she bonded immediately with the examiner.

Diagnoses may be inappropriately applied, and pre-existing personality disorders are simply not mentioned in the report.

In toto, the report will read as if: The referral agent “wants me to find something wrong with this patient, and it is all to be attributable to the injury.” From the opening sentence of the report, there is a sense that the report will not be accurate or complete. And indeed, it will not.”

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