Dr. David B. Adams – Psychological Blog

Psychology of Injury, Pain, Anxiety and Depression

Misdiagnosis and Protracted Care

A panel physician who can find nothing wrong with the patient. The patient continues to complain and is sent to a specialist who orders a series of tests.

The tests may reveal a surgical condition, or they may not. The patient receives treatment, sometimes surgery, and they reach MMI. One would expect the patient to be released by the specialist.

However, the patient is then sent to a pain center, and there they languish on many, many drugs, and no one, especially the patient, ever gets closure.

It can be what is called _turfing._ Turfing means: “When I have done all that I can do, and I do not want the responsibility of putting closure on the injury for the patient, I refer the patient to someone else.”

And this pattern may continue through several other specialists.

Sometimes it is due to a genuine belief that _well, I cannot do anything further for this patient, but I know someone who can._

Sometimes it is due to fear that the patient will become angered that I could do no more. So I send them elsewhere so that the patient can be angry at the next guy rather than me.

Sometimes, unfortunately, it is an _arrangement_ that I have with the next guy. I send him patients, and he sends me patients. We keep each other in business.

But it truly does not matter why I am turfing this patient. The reality is that the patient is looking to me for their understanding and acceptance of their condition. By turfing them, I fail to meet those needs of the patient and the expectancies of others who asked that I see the patient.

If I am the primary authorized treating clinician, it is my responsibility to let the patient know that:

_Unfortunately, there is nothing more that I can do. And my best clinical judgment is that no one else can do more for you. This is where you have to begin accepting your limitations and residual pain. You must learn to cope with it. I can send you to someone who can help you to learn to cope, but no one can take away all of your symptoms. I do not want to send you to anyone else unless you understand that this is my best clinical judgment. Now I want to take time to explain to you what is wrong, why your symptoms will continue and reassure you that there are productive things that you can do with your life once you accept all that I am about to tell you._

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