Dr. David B. Adams – Psychological Blog

Psychology of Illness, Pain, Anxiety and Depression


Many/most patients who are injured are immediately placed in a position of helplessness. Those who have been assaulted are also frightened and angered at their assailant. Since many employers do not respond effectively to the assaulted patient, the patient then becomes angry and alienated from the employer no matter how long they have been employed.

The patient has only two advocates: their physician and their attorney. If the attorney does not have their best interests at heart, wishes only to build the value of the “case” and is not completely honest with information imparted, the patient typically is unaware that this is occurring. So when the insurer (or employer) questions care-related charges, the patient is solely reliant upon the attorney for interpretation of why this is happening. The attorney does not typically calm the patient and most often does not have the requisite skills and may not recognize the need to do so.

The treating physician is either an individual of great suspect or great trust by the patient. His feelings toward the physician are unlikely to change. The patient may trust or suspect his doctor independent of reality. That is, the patient may distrust anyone to whom they have been sent by the employer. Or conversely, the patient may completely trust anyone to whom their attorney has sent them. These are emotional responses and are quite often not based upon any real data or good reality-testing.

If the treating physician is a charming, persuasive and manipulative individual, the patient will invest undeserved trust in him/her. The patient becomes protective of the doctor even though the doctor is not providing effective or even appropriate care. The patient may even know that he has more pain (or other limitations) over time while under this doctor’s care. Nonetheless, he continues to believe in the doctor and becomes entrenched in that care and quite resistant to leave.

When you intervene, even on behalf the patient’s best interests, the patient immediately distorts what is happening. His self-talk sounds much like: “Dr. Jones has recommended some painful and difficult procedures. I am in worse pain. But my pain is worse because I have so many injury-related problems, and they only want me away from Dr. Jones to save themselves money. Dr. Jones is the only one who understands how badly I have been hurt, and how I suffer. I cannot stop them from taking me away from Dr. Jones, and, therefore, I now feel totally helpless. I am now depressed solely because of not being able to see Dr. Jones. I feel all of this is hopeless, and I hate these people who are keeping me from seeing him.”

It is critical to the management of these patients that you determine whether the doctor-patient relationship is becoming dysfunctional, whether the patient is distorting the nature and value of care and whether the patient should not be moved to another provider before further pathological attachments occur.”

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