Dr. David B. Adams – Psychological Blog

Psychology of Illness, Pain, Anxiety and Depression

(Too?) Early Return to Work

What about those that are not exacerbated but just pre-existing? I am talking about those who carry problems into an injury, and the injury has not made the problems worse. Do patients take advantage of open access to care just as they may do with access to narcotics

This is what I label the goose that concurrently lays two golden eggs.

The patient, as is true in the cases of 1/3 of all injured workers, has one of more psychological disorders and countless personal problems that he/she has had for many years.

The individual gets injured, and what emerges are two fresh opportunities:

1. I can now get “free” care for my myriad of longstanding problems including medication to make me to feel better emotionally, and

2. This will increase the “financial value” of my case for which I will receive a greater cash treasure chest when it closes.

You may feel that this is particularly annoying and unfair. However, an even greater problem is that the patient is being encouraged by outside sources to tie together these unrelated issues for financial gain. In such cases, the patient is very reluctant to accept termination of care.

For the sake of the patient, there must be:

a. a diagnostic determination that not only tells you what is going on but also why it is occurring and for how long it has existed

b. an assessment of pre-injury baseline functioning. Insist upon a statement of probable length of time required to return to baseline (in many cases, the patient is already at baseline but this baseline was always a compromised level of functioning).

c. a treatment plan that includes number, duration and spacing of visits

d. authorization of additional care after a review after the delivered care’s benefit is determined determined.

Far too often, when a patient elects not to improve, enjoys being in treatment, finds that it gives him/her something to do, those treating the patient erroneously believe that somehow additional care will divert the path that the patient is following. It almost never does.

Always be certain of relatedness to injury and specifically how treatment will improve the quality of the patient’s life.

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