A patient has a severe dominant arm injury. When his pain became manageable, his surgeon ordered an FCE, and based upon the results, planned to release him MMI with a significant PPD. No more can be done, but then the patient suddenly reported renewed complaints of severe pain. I am going to make several informed assumptions: This patient injured his arm in the performance of either a skilled or semi-skilled labor job. His employer has no other work for him. He has insufficient education for any employment of which he is currently aware.
Obviously, this covers a large number of injured workers, but allow me to add a decisive factor: His family has fatigued with his longstanding disability role. They have tired of his irritability, demandedness and instability of mood. They have tired of their lives being bound up in his injury and their future being controlled by the outcome of this injury.
He has had no responsibility to them for independently finding something to financially support and now emotionally support them.
Thus, as long as he is a _patient_, all affection, attention, support and concern flows toward him. As soon as he is released, he is expected to assume responsibility for both himself and his family.
His life was characterized by working hard, and perhaps he had no difficulty finding work that paid more than his education would have dictated. He never planned for such concepts as disability.
He is now responsible for living the rest of his life, is fearful of the future, resentful and feels helpless. He turns to the only thing which has worked in the past: his injury, pain and limitations. He is consciously hopeful that the family will continue to relieve him of responsibility since clearly he is not responsible for their predicament and the emptiness of their lives.
Unfortunately, this relying upon a “resolved” injury to escape the responsibilities of family is only briefly effective. This is why it is important, from the time an injury first occurs, to keep the patient oriented towards recovery rather than allowing them to focus only upon their injury. It is the same reason that hospital nursing care plans address discharge goals as part of the initial assessment and planning.
#AtlantaPsychologist #AtlantaMedicalPsychology #Dr. David B. Adams #Pain #Depression #Anxiety