Dr. David B. Adams – Psychological Blog

Psychology of Injury, Pain, Anxiety and Depression

"Doctor-Patient Relationship"

The doctor-patient relationship is the cornerstone to health and management of illness and injury. Patients in America have had appreciable discretion and control in that relationship.

The patient could determine which doctor he/she sees, where and when to be seen, and can elect to end the relationship if it is felt to be nonproductive. Diagnostic tests, medication and other therapies are immediately available.

Individuals grow up within this health care delivery system and acclimate to the freedom and independence that it entails. Similarly, physicians are accustomed to ordering diagnostic tests and lab studies at their own discretion, as long as the diagnostic codes are consistent with the insurer’s review processing.

Under workers’ compensation, however, most familiar freedoms become very limited or nonexistent. Referrals are made from within a panel, often directed specifically by the employer, clinicians must request specific approval from insurers, and injured workers may find that the tests and procedures that their physicians say are necessary have been declined or postponed.

The patient soon feels that it is no longer a doctor-patient relationship, but instead a doctor-employer relationship.

Quite often, the patient will also be asked to seen an independent clinician in which there is no semblance of a relationship.

The patient does not acclimate to this lack of control but instead begins to experience suspicion and resentment. He/she then becomes vulnerable to distorted thinking when told that their doctors, employer, insurer and nurse case manager “do not care about you.

It is a serious flaw in the workers’ compensation system when the basic relationship that serves as the foundation for all health care delivery is disrupted. Aside from the moral and integrity issues, this process slows the course of recovery.”

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