Much of what we do, comes from systems that exist or that we create. Whether we talk about organ systems or the workers’ compensation system, there are certain predictable events, processes and outcomes that enable us to do our work.
Some of what we do falls far outside of what we anticipate based upon our knowledge of a system. An infection does not respond as we predict, an injury does not heal as we would expect, and a patient does not respond as we feel he should.
The workers’ compensation system is complicated by an unequal distribution of motivation, pain tolerance, past exposure to trauma and educational differences. The person who responds best to the system is one who is reasonably compliant, asks few questions and has a great deal of patience. The system works better for those with stable financial and family resources because both will be taxed after injury, and the system works best for those for whom the extent of their injury is fully discovered during the very early stages of treatment.
The workers’ compensation system is not ideally suited for the very inquisitive, the very compulsive, the highly skeptical, the impatient or the fearful. They find that delays in diagnosis, delays in authorization for care, disputes over relatedness of complaints, and demands that they be passively compliant, are at odds with their very nature.
I suspect that in the case of your patient, he is a compulsive and organized individual who feared that his subjective complaints indicated something far more concerning than a sprain. He also is aware that the system in which he finds himself is far different than seeing his personal physical where there is continuity of care and more opportunity for patient discussion and education. He may have felt dismissed, disbelieved and minimized by the workers’ compensation system. While he likely overhears some patients talk about how they do not wish to return to work, he may feel it essential to return to work and restore his level of income.
I have found that expressing support for their situation, and acknowledging that they, indeed, do not “fit the mold” of the system in which they find themselves, often reassures them that they are understood and will be seen as individuals. Offer to take five minutes at the end of an exam to explain what you are thinking and encourage to ask questions, express doubts and frustrations and that you will make a note of their concerns.