Dr. David B. Adams – Psychological Blog

Psychology of Injury, Pain, Anxiety and Depression

When Psychodiagnosis is Indicated

There are four reasons for making a psychological referral:

1. You arequest a second opinion because you have reason to believe that current care is either inadequate or inappropriate. This may be due to duration of care, frequency of care or concern for whether the need for care is related to this injury. To say that all care is appropriate is naive. To say all care is unwarranted is inaccurate.

2. The physician wishes to determine whether there are psychological factors or a specific disorder that may be impeding physical recovery. This would also include whether the patient is psychologically prepared for a procedure for which authorization is being sought.

3. The patient’s attorney may request a psychological referral as part of the settlement process.

4. However, there is one reason for making a psychological referral that is wholly inappropriate if not cruel; those cases in which the psychological diagnosis is being sought solely to facilitate denial of care. In this case, the patient may have had symptoms of anxiety (Eg. PTSD) or mood disorder (Eg. major depressive disorder) since the injury. The patient and/or authorized treating physician have repeatedly sought to make a psychological referral, and authorization could not be obtained. Now the patient is being referred because a hearing is imminent, or with the hope that there will be a psychological diagnostic finding that can be utilized to obstruct a proposed procedure.

The resistance to authorizing psychological care arises from two factors:

a. Negative past experiences in which such care merely complicated and prolonged the recovery process
b. Your own poor understanding of psychopathology (mental disorders) and, therefore, believing that the mind and body are separate and distinct and that psychological problems pre-exist but rarely arise from injury.

As always, the greatest concern should be for those patients (assault, burn, amputation and other trauma) for whom early care is clearly indicated and postponed care is highly destructive.”

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