Dr. David B. Adams – Psychological Blog

Psychology of Illness, Pain, Anxiety and Depression

Vegetative Living

In order for an injured worker to recover, I feel he needs to participate in his own rehabilitation.

Let_s differentiate between two roles for the injured worker:

a. Assuming responsibility for his course of care
b. Taking on the role of case manager

In terms of assuming responsibility, the patient would maintain reasonable health habits. This would include managing comorbid conditions such as hypertension and diabetes. It would mean that the patient would maintain reasonable diet and exercise within objective limits imposed by injury. It would involve asking sufficient questions about the injury and treatment to have adequate understanding of the true implications of the damages incurred. It would also mean being certain to show for appointments and adhering to a prescribed course of care.

However, far too many patients begin to assume the role of their own case manager. They begin making decisions beyond their level of competence and making decisions that are nonproductive or counterproductive in terms of recovery.

Why do they do this? Almost always this is a defense against accepting their dependent role.
They become an assumed _expert_ as to which physician, which procedure and which therapy is indicated for the problems they have. They become immersed in these concepts to keep themselves from addressing the real dilemma: _What am I going to do with my own future?_

They will spend time preparing for hearings, finding fault with those responsible for their care and becoming their own legal and clinical consultant. And this pattern of behavior rapidly becomes self-destructive; others cease to battle them for control and let them spin off into their ill-informed and poorly conceived self case management.

To prevent this from occurring, all of us must recognize its early signs. These include hostility, belligerence, denigrating remarks and increased use of medical nosology. Unfortunately, these behaviors increase with the intelligence of the injured worker. Thus, the patient with the greatest resources for alternate/light/administrative duties instead becomes the author of his own demise.

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