Dr. David B. Adams – Psychological Blog

Psychology of Illness, Pain, Anxiety and Depression

Cruel But Not Unusual

In my practice, I see closure (MMI release) that, to the patient, seems to be needlessly postponed.

Equally as often, my patients do not know that closure is forthcoming and are stunned and/or angry that they are released.

The reason of the authorized treating physician is often: `The patient should not be told the severity nor permanence of his/her limitations since this will be discouraging and interfere with rehabilitative efforts._

Additionally, `I am very reluctant to release others patients whom I sense are not prepared to for life after injury._

Therefore, it is better to encourage the patient to cling to the hope and belief that recovery will be to pre-injury levels, that there will be no chronic limitations and that pain will resolve.

This reasoning is faulty if not irresponsible and cruel.

Many patients understands decidedly little about the condition and often little about the probable outcome of surgery. The patient also may not know what treatment options remain available and will wait, often impatiently, for change that is not forthcoming.

The patient spends idle days, entertained by naps and television, fielding oppressive phone calls from collection agencies. The family, once a source of support, now becomes a source of shame and guilt for the obligations that the injured worker can no longer fulfill.

Injuries are always physical conditions. However, dealing with an altered life is wholly a psychological issue. Release, even with limitations, must be seen as a goal, rather than a punishment.”

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