Dr. David B. Adams – Psychological Blog

Psychology of Illness, Pain, Anxiety and Depression

Why Referrals are Declined

There are doctors who refuse referrals of injured workers. They most often claim that workers’ comp patients treat doctors and staff differently whether it is compliance with care or courtesy while in the office.

In fact, many if not most injured workers respond differently than do private patients to the same standard of care delivery. Often, they feel no individual attachment to their doctors since they did not seek them, select them nor form relationships with them. There is a large measure of detachment.

However, it is a bit more complex than just describing their behavior. You must also understand what gives rise to it.

If you speak in general terms, most injured workers come from industrial environments, with a set work schedule and delineated tasks. The majority has not pursued advanced educational and training options, and career aspirations were limited to reliably working, earning, and effective spending.

In turn, their retirement plans are associated with plans made for them by their employer and do not involve individual investment accounts or elaborate economic plans. Job advancement and salary increases are associated with pay raises, pay grade changes and promotion within their current work setting.

Indeed, a large number of those working in construction may have had seasonal work and multiple employers. Their daily schedules were determined by availability of work.

When such a worker is injured, all of this structure ceases. They now rely upon checks, reimbursement and authorization for care that is managed by others; most often by others whom they have never met.

They have no financial commitment to the doctors whom they see. And there is no penalty for arriving late or simply failing to show for an appointment. They realize that continuity of care will end as soon as they are out of the workers’ compensation system. They likely will never see those doctors again. Often, they believe, sometimes with accuracy, that the doctors they see under workers’ compensation have no emotional/personal investment in them as individuals. Accurate or not, they sense this detachment and respond with their own lack of fidelity or concern for the doctor or his/her staff. The patient may be loathe to express gratitude, appreciation or even common social courtesies. Instead, they may be suspicious, demanding and openly hostile.

At the same time, the average injured worker, may lack education, training and experience to have chosen their own doctor, especially for an injury they would have never expected to occur.

It would be helpful if nurse case managers and claims adjustors helped the patient to understand that they will gain a great deal by investing in the doctor-patient relationship…or, at a minimum, understand why the lack of such a relationship is an obstacle to effective care.

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