Unfortunately, the risk to life and risk of law suit, forces everyone to practice defensively.
This means that even though you find nothing, you continue to look. A woman from another country wrote me recently that her all lab tests indicate that her depressed daughter is physically healthy, yet she runs a low grade fever every day.
While it is tempting to say that the fever is stress-related, you immediately become concerned that some significant physical problem is being overlooked.
Thus, when an injured worker has no objective reason for the pain, the search for a physical cause continues for many months beyond the point where the doctor is certain that there no physical cause will ever be found.
The patient is then sent to a pain center which also assumes that the pain is physical and numerous procedures and medications are used for another period extending months_and sometimes years.
Then, three years after the injury, someone takes a gamble and says _this is probably psychological._
I see the patient at that time, and it is stunning how many horrible (not related to injury) events have happened and are happening in the patient_s life.
By this time, the patient may have become completely resistant to accepting that his/her problems are not related to injury.
Early cop-outs on the psychological diagnosis always lead to later problems.