If the injured worker is asked “Will you ever be able to work again?” the following responses can be categorized:
a. “They tell me that I won’t ever be able to” – the patient has accepted, appropriately or not, that a return to work will not occur.
b. “Well, I would like to, but I don’t see how” – the patient has become fixed in a perception that his/her limitations preclude any productive return to the workforce.
c. “Well, I can’t return to work doing what I used to do.” – the patient wishes to return to work but is uncertain of his/her options.
d. “If they have another job for me (at the company where injured).” – the patient anticipates that, with assistance, he/she can work modified or alternate duty work for the current employer or another.
e. “I have no choice; the family needs the money (or “I would not know what to do if I was not working” or “I have to because sitting at home is miserable”) – the patient is committed to finding work within his/her objective limitations.
Part of this decision-making process is determined by the individual’s personal work ethic and motivation as well as education and definable career path. If the individual has consistently worked, seen their work as a career, and finds self-esteem in a sense of accomplishment and productivity, he/she is likely to return to work in some capacity.
But an equal part is shaped by the perceptions of those around them. Thus, the earlier in the recovery process that this question is asked, and the higher the expectation of health care personnel that an injured worker should strive for productivity, the more they will incorporate return to work into the mental process of recovery. The patient’s focus upon somatic symptoms was once called “hypochondriac.”
Conversely, the more that treatment drags on, the more changes of physicians, and the more nonproductive the course of care, the easier that patient will settle into a self-concept of disability regardless of age or education.