Within the first twelve months of injury:
1. The patient has become increasingly alienated from coworkers and the employer whom they now strongly feel has abandoned him/her
2. The patient_s expectancy that this would be short term medical care has been quashed
3. The patient_s relationship with nurse case manager and his/her own family will increasingly become strained or compromised
4. The patient has seen multiple providers, sometimes with conflicting goals, and may now have incompatible diagnoses
5. The patient has become concurrently irritable but also both passive and dependent
6. The financial picture has become very bleak and is worsening
7. The patient has become sedentary, de-conditioned and unmotivated
8. The patient spends increasing time counter-productively, over-medicating, sleeping and over-eating
9. The patient has become focused upon issues of rights and authorization of care rather than issues of improvement
10. The patient now has developed no clear career alternatives, conceived goals or direction
11. The patient has become very conflicted as to where to invest trust and hope
12. All holidays, special events and other meaningful landmarks of time have now passed with the patient in a disability role
Within those first twelve months, the patient has all but established a new personal identity. Their values and belief systems have been altered, and their belief that they can change the course of their future have eroded.
The best time to mobilize these patients is before the end of that first year, and the best way to do so is to help them challenge these developing, faulty belief systems.