Several years ago, I had a patient who had fallen greater than 20 feet from a roof he was repairing. This occurred at work. He sustained numerous fractures to all four limbs as well as to the face and jaw. He had surgeries that spanned three years.
He recounted to me that on one meeting with his surgeon, when he was complaining about pain and limitations, the surgeon bluntly told him that had this happened one hundred years ago, he would be expected to get back out into the fields and carry out his daily responsibilities. There he was, the surgeon continued, being provided with both medical care and some degree of financial support.
For complex reasons, this was a life changing confrontation in which the patient realized that he was free to complain largely because there were almost no expectancies being made of him.
In answer to your question:
What if the patient had sustained this injury while working on his own roof? Would he continue to have income? Would he have health insurance to provide him quality of care?
Our perceptions of illness and injury is largely dictated by the context, boundaries and benefits in which these events occur. If we sustain a domestic injury, and we have no family or friends, we must fend for ourselves. If we have no source of income, we may have to borrow money and sell-off possessions just to cover what medical care we can obtain.
Our reward for reaching maximum medical improvement in a domestic injury is not correlated with a financial settlement but with simply the freedom to return to whatever work we can now perform within our limitations.
And in the context of domestic injury, there is no benefit to being seen as psychologically disabled because we know employers are not likely to hire someone with documented psychological limitations.
And with domestic injuries, we are unlikely to miss or skip appointments, unlikely to fail to comply with therapies, and we certainly are unlikely to doctor-shop since such actions will extend the timeframe needed to re-enter the workforce.
You are correct that the context in which the injury occurs, and whether it is financially compensated, is a major factor in the way in which we, as patients, respond to trauma.
When any of my patients begin to decry the misery of their plight, I ask that they also consider the same injury occurring in a domestic setting and to reassess whether all of their protestations are valid.