Dr. David B. Adams – Psychological Blog

Psychology of Illness, Pain, Anxiety and Depression

Pre-Injury Health Concerns

There is a diagnosis (316.0 Maladaptive Health Behaviors Affecting Physical Condition) which addresses the self-abuse through which we place our bodies.

A significant number of injured workers are obese, de-conditioned with high levels of nicotine, caffeine and/or alcohol intake. They are genetically predisposed to hypertension and diabetes, and many are already undiagnosed cases of Type II Diabetes prior to injury.

After injury, they are sedentary, diet is unhealthy, and their underlying problems worsen. They do not have regular mammography or prostate exams, and I have seen numerous cases where, during the case of recovery from injury, they develop lung, breast or prostate cancers. Some develop peripheral neuropathies from their undiagnosed diabetes. The only health care they receive is that related to their injury, and their authorized treating (orthopedist for example) is not empowered by the employer/insurer to look for these conditions.

All assume that the patient sees one group of physicians for his/her injury and another for routine ongoing health care. Most often, this could not be further from the truth.

As these underlying and co-existing health problems increase, the patient_s ability to recover from injury decreases. Eventually the boundaries between injury and unrelated health problems begin to blur. Is the patient short of breath because of chronic pain, obesity or chronic obstructive pulmonary disease from smoking?

Although not typically part of a psychological exam, I always inquire into how recent was this weight gain (or loss), what other (unrelated to injury) symptoms the patient is having and, most of all, do they have access to routine health care. Unless I ask these questions, those data rarely emerge in the patient_s chart.

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