Dr. David B. Adams – Psychological Blog

Psychology of Injury, Pain, Anxiety and Depression

Protracted & Nonproductive Care

It can be quite difficult to manage those injured workers who are foreign born. The vast differences among various ethnic groups may be significant. INot only language barriers but cultural differences, differences in values and certainly differences in pain tolerance and motivation.

Problems with the immigrant injured worker:

[LIST]
[*]may well be in the country illegally and, therefore, very secretive about their life other than their most immediate injury-related complaints
[*]
[*]obtaining a valid and reliable past medical history may be impossible due to non-disclosure, complicated by language barriers
[*]
[*]may have come to this country due to hardship in their native land [especially true in (former) Soviet countries].
[*]
[*]have expectations that more will be done for them in America, with less personal responsibility, than was true in their homeland.
[*]
[*]may well approach all health care providers with suspicion and distrust
[*]
[*]may not understand and/or may refuse to comply with care as it is prescribed
[*]
[*]will find it easier to accept disability income than to seek another job in our country
[*]
[*]will have complex family and social problems that governs the course of their recovery
[*]
[*]may be vulnerable and dependent upon those who instruct them not to put forth effort
[/LIST]

Solutions:

[LIST=1]
[*]do not impose American values upon those who do not share them; begin with a clean slate that essentially says “this person may not share my urgency in their returning to work.”
[*]
[*]always have access to an objective interpreter who understands the customs, values and ethics of the homeland (and America) and who can explain them what you are willing and able to do for the injured worker
[*]
[*]make certain that all involved in care are aware that this individual may have needs that we may not frequently see in our own culture
[*]
[*]do not be victim to the patient’s wishing this injury to compensate for a past life of misery
[*]
[*]accept that administrative closure may be needed earlier in these cases in order to best help the injured worker mobilize
[/LIST]
Please note that some of these individuals, injured while doing semi-skilled production work in America were, in fact, doctors and lawyers in their homeland. Prior to being forced out of their country, they held positions of power and prestige. Fleeing their country in fear, only now can they process their bitterness and resentment.

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