There is an interesting and important article (Lancet. 2007;370:1146-1152) which states in part: “It is very important for clinicians to be aware that they are not risking the fragile health of their patients by getting them back to work. We should take more risks in encouraging even very disabled patients to seek work with assistance.”
The authors also note: “Europe has less of a “hire-and-fire” culture than the United States, and its more generous welfare system might create a “benefit trap,” where patients could face real or perceived financial disincentives for returning to work.”
We daily see patients who would better be served by being back in the marketplace. They would feel greater worth, feel less hopeless, be less of a burden to friends and family and can contribute to society. However, there are forces that encourage dependency, often exaggerated disability and provide assistance in finding financial rewards for non-productivity.
Are there people who are totally disabled by pain? Yes, but these are rare. Are there patients totally disabled by depression? Unquestionably, but these are few. Many patients have productive things that they can, and want to, do despite their pain. Many have alternate skills, and most loathe the role of remaining at home. But when their disability income is equivalent to that obtained by working, and disability income is given almost as a reward for staying in bed, fewer each month attempt to mobilize their remaining resources.
When managing patients, whether they be in pain and/or depressed, it is important to step back and determine objectively if these patients can obtain not only self-worth but actual symptomatic relief from the daily competition and interactions in the workplace.