Dr. David B. Adams – Psychological Blog

Psychology of Illness, Pain, Anxiety and Depression

The Great Entrenchment

Entrenchment is not a good thing. Its true definition comes from the military where it is a type of fortification created by digging.

In the case of personal injury, the patient becomes entrenched (dug in) to their complaints, their care and their own perceptions of disability, and they fortify (or resist) so that they cannot be moved forward.

This quite often happens when they fall into the hands (practice) of a clinician (primary doctor) who continues to treat despite making no progress in resolving the patient’s complaints. The doctor becomes unwilling to release or refer the patient, and the patient begins to believe that only this doctor can be of help…even though the patient has shown little or no benefit to remaining in the care of this doctor.

This is entrenchment. And the patient often becomes a staunch supporter of the doctor even though no one else involved in the case feels that the doctor is helping the patient.

The patient begins to feel that he must protect the doctor from the outside criticism. The patient fights to remain in the car although months, and sometimes years, have elapsed without improvement.

The doctor becomes dependent upon the patient, either emotionally and/or financially, and cannot act upon the reality that he has provided little of lasting benefit to the patient.

The best solution, as always, is prevention; look for too frequent visits, unproved treatment approaches, struggles to maintain control of the patient as well as indication in notes that the doctor believes that he has to protect the patient from malevolent sources including employer, insurer and even the patient’s family.

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