Dr. David B. Adams – Psychological Blog

Psychology of Illness, Pain, Anxiety and Depression

Complete and Competent

A competent psychological exam is intended to provide a very complete summary of the patient, what factors make this patient unique and what specifically is needed to help him/her. A report that provides simply a diagnosis and care recommendations will often miss those factors which will prevent this particular patient from responding to ordinary and customary care.

An examination begins with a better understanding of how the injury actually occurred, including such factors as whether the patient faults the employer, coworkers or defective devices as the cause of the accident. Following the accident, what actions were taken on behalf of the patient? Were attempts made to contain costs, including either not facilitating timely care or ordering the employee to continue working despite injury. Additional data regarding the course of care are crucial: aspects such as whom s/he has seen, what procedures were attempted, how the patient assesses the quality of care and the investment of the authorized treating physician.

Equally as important is the nature of the patient’s support system. Is family fearful, angered, resentful, distrustful or impatient at this stage of injury treatment? What is the complete history of this patient including family incidence of disabling conditions, work-injury in authority figures, educational resources for alternate employment as well as employment history.

Arguably, one of the most important factors is the patient’s age. It is not uncommon for patients injured at mid-life to feel that mobilization for a career change is simply not possible, debt-load is too great, family endorsement of career change is nonexistent. Injuries occurring during the mid-to-late 50s are often impacting those who were focused on retirement as a goal and also beginning the slippery slope of late life medical problems. For this latter group, the concept of seeking a new employment direction seems impossible to them, and there is the concurrent belief that a new employer would not want someone their age.

A psychological exam that sees patient history as beginning at the time of injury is an ill-conceived assessment and is not only nonproductive but simply inappropriate for an injured worker.

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