The following case history will be very familiar to most of you. This is a middle aged man, sustaining work-related back injury while working a clerical position for an accounting firm.
His lumbar injury occurred when his manager required that he help lift huge executive desks to save on moving expenses.
Due to compromised gait, he then fell and tore the meniscus in his right knee.
It then became the frequently seen “house of cards:”
The employer denied that even the initial injury was work-related,
– the insurer delayed in authorizing tests,
– and the providers repeatedly attempted to return him to work after communication with the employer.
The patient required more than expected psychological support. He was angry, resentful, increasingly suspicious and in chronic pain. He was frustrated by delays. He was fearful that the knee would never be addressed and that he “would become paralyzed from the back injury.”
No one had spent time educating him about his back or his increasingly poor health habits (morbid obesity, smoking, drinking, etc). His financial situation became grim.
With appreciable effort in getting everyone involved to understand his plight, he finally received authorization, care and the surgeries he needed.
However, after a mediation hearing and settlement agreement, the patient then became secretive and guarded (to all), having “been told not to tell anyone the details of my settlement” (although these details impacted future treatment planning for all involved in his care).
It was much more difficult to treat the patient after the mediation. Up until that point, he pleaded for any assistance he could find. After the hearing, he became unworkable. This, unfortunately, is yet another part of the psychology of injury management, and one for which you need to anticipate.