The drama of trauma: events occur in a context. That context fuels the drama that surrounds the injury. Injury always has a context. Whether it is a slip and fall, a lifting injury, a laceration or an assault, there is a complex setting in which injury occurs.
That setting consists not only of location and environmental factors, but it is comprised of the people present (or absent) at the time of injury. It includes events that preceeded the injury including whether the employee knew he/she was being put in harms way. It also encompasses the relationship of the employee to coworkers and superiors at the time of the injury.
The injury may, therefore, be due to the deliberate action of others such as assault. The injury may be due to the negligence of others who failed to repair a machine, to effectively perform their own job or even the lack of staff available for the job to be safely performed.
The worker goes into the setting with either reasonable reassurance that the setting and tasks are safe, or he goes into the situation carrying apprehension, perhaps resentment of what is being required of him, and often preoccupation with personal problems.
When the injury occurs, all manner of factors come to bear of which we were not previously aware:
a. The motives and integrity of the employer
b. The investment of initial medical providers
c. The timeliness and effectiveness of care
d. The assistance/compassion shown by coworkers
e. The status of the workers’ support system
f. The workers’ financial capacity to deal with reduced income
Each injury has its own drama; its own stage with players, villains, reprobates and heros.
Treating an injury without understanding the “drama” of the context is fraught with problems. Injured workers who do not respond to standards of care, who are difficult to manage, who recover poorly and those who will not comply with medical directives, are acting-out within the drama of their injury.
The knowledge of how this injury fits within the context of the injured-worker’s life is essential to effective case management.