Dr. David B. Adams – Psychological Blog

Psychology of Injury, Pain, Anxiety and Depression

Disability or Disorder

The last thirty years have taught me that there is truly only one effective approach, and this applies to surgeons, nurses adjustors and employers:

Wherever possible, be certain that you do the following:

Stop talking to the patient and listen carefully. Do not ask “yes” or “no” questions regarding the injury, but, instead, ask for a narrative as to how the patient sees the injury to have occurred, and how he/she feels it could have been avoided.

Rather than interrupting the patient, allow the patient to complete the narrative and then ask for clarification of key points.

Summarize back to the patient what you feel you were just told to be certain that the two of you share in understanding the patient’s rendition of events.

When explaining to the patient, regardless of your perception of his/her educational and intellectual limits, simplify what you are attempting to explain; avoid the use of terms that you assume both of you understand.

Realize that you may have gender differences in how you perceive the patient’s plight: Males and females have vastly different perceptions of their responsibilities and roles. Do not impose yours upon his/hers.

Similarly, there are cultural differences. Be open to hearing that the patient feels that the injury was an act of God or that a melodramatic response to injury is culturally expected for this particular patient.

Be certain that your true level of availability is clearly communicated. Too often, in an attempt to be supportive, we behave as though the patient can “call us at any time” and are then stunned to find out that the patient took that literally.

Ask the patient to summarize for you what he/she feels that you have just explained (this may obviate believing that a fusion entails “putting fuses in my back”…or…that the plan is to “take out these ruptured ones and put brand new ones in there”).

Note that the effects of medication, pain, anxiety, depression and distrust effectively impede with the patient’s ability to listen and remember. Look for one or more of these obstacles and slow the discussion to insure that data is accurately being communicated between the two of you.

Always assume that the patient has many things going on concurrently in his/her life and that this injury is not the only event of which you should be aware. Sometimes, it is not even the most important. Suspect that the patient has numerous complications in life and provide an environment wherein he/she can share these with you.

If you, for any reason, feel that you have neither the time, inclination, training or skill to secure and impart data as outlined above, have someone else see the patient to insure that the interchange occurs.

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