When psychological issues arise or abound, the person who should recognize these factors is the authorized treating physician. That would be someone at the occupational health center you use, the treating surgeon, neurologist or other specialist. He is in the best position to note that the patient’s complaints do not “match up” with known physical problems.
He is the first to see that the patient either has excessive or illogical symptoms. Before he continues treating this patient or referring the patient to a pain center, he would record his concerns and recommend psychological consult.
But most often, he will not. Why?
Well, he is aware that the insurer may authorize repeated MRI, CT-scan, myelogram etc before authorizing a single psychological consult. The patient and his attorney feel the same way.
So while the primary physician has strong doubts about the symptoms, everyone continues as though the symptoms make perfect sense and that pursuing the same line of thinking will eventually result in a different conclusion.
It is all very irrational and wasteful of time and resources.
When you see a case, review a chart or receive billing for a patient who should have long ago recovered, you must contact the primary provider, suggest that perhaps “something else is going on, and should we not be investigating that.”
Your plumber is unlikely to mention that he suspects you also have an electrical problem…unless he is standing in a puddle holding a live wire.