Dr. David B. Adams – Psychological Blog

Psychology of Injury, Pain, Anxiety and Depression

Maximally Medically Improved

Reaching the point of maximum medical improvement does not insure a return to productivity. Most of the time there are other agenda that are impacting the patient, and if he/she elects not to return to work, this is not the end but the beginning of a whole new series of challenges and problems for you. With other agenda in operation, the patient will seek additional opinions and emphasize other complaints.

Using the MMI criteria, the patient will now relinquish all subjective complaints (e.g. pain). You must assume also that the employer will comply with whatever restrictions have been assigned. You must also assume that the patient is fully functional from a psychological perspective. That is, the patient and family are coping with the financial aftermath of the injury, that the patient can emotionally deal with permanent limitations regardless of their scope, and that the family unit remains intact after months or years of living a disability lifestyle.

So, I suspect that MMI does not, in fact, “clear” a case. We tend to view all physical conditions as though they can be defined totally in terms of objective measurements (xray, MRI, CT-scan, etc). The reality is that there is often extreme variability between and among patients with essentially identical injuries. You may have an uneducated, obese, hypertensive, diabetic middle aged patient with a lumbar injury, or you may have the same injury in a high school educated, otherwise healthy, patient who has always lived on the brink of financial despair. Each will respond to being released MMI in quite different ways.

Dare I repeat that: it is often far more important to know what type of patient has the injury as it is what type of injury the patient has.

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