Dr. David B. Adams – Psychological Blog

Psychology of Injury, Pain, Anxiety and Depression

Disrupted Relationship

It is difficult for me to understand how surgeons obtain so little information about the patient that they are treating. They appear to treat a condition without knowing the patient behind the condition.

If you change the clinical relationship from one in which patient and doctor choose each other and money changes hands directly, you change the nature of that relationship of investment and accountability in both directions. It is human nature. A private paying patient will invest time in knowing who you are, what you do well and your expectancies.

When external parties manage referrals, payment and authorization, the foundation for a relationship has been altered. Is the bond between doctor and patient, or between doctor and faceless payer? Injured workers perceive it as the latter.

The lack of a bonding and enduring doctor-patient relationship is a core feature…and core problem…of the workers’ compensation system. Most often the patient did not choose to see this doctor, and the reverse is also true. While the patient approaches care initially with optimism, this all too quickly turns to suspicion and doubt when he/she senses a lack of personal investment from the doctor. The patient begins to believe that the primary relationship is with this third party. The patient senses that the doctor wants more referrals from this third party and that his investment is in pleasing them.

If the patient’s condition fails to improve, or improves more slowly than the patient anticipated, the patient is vulnerable to doubts about their provider, and often those doubts are unfairly magnified by the comments of others. The system not only lacks attachment between doctor and patient, it becomes adversarial and from the patient_s perspective, secretly colluding. Statistically, private patients return to work more quickly when they know they have no alternative but to do so or lose all income. Physicians know this as well as statisticians.

The other aspect of this relationship is total transparency, with no HIPAA protection of medical records. Most injured workers know this, and it gives them pause to share histories of substance abuse, legal, marital, financial and social problems. This withholding of data is like any secret _ it changes the nature of the relationship.

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