Dr. David B. Adams – Psychological Blog

Psychology of Illness, Pain, Anxiety and Depression

“Timing Can Be Everything”

 

The Timing of Intervention

Timing of patient careThere is a slowing of the recovery process near the time of settlement. Patients express confusion about this sudden slowing of the process but quite often, they are unwittingly part of its creation.

Many patients have a very distant relationship with their attorneys. And most have a severely eroded or non-existent relationship with their employer. The intermediary between them and their emplorer should be their attorney, often replaced by a relationship with a paralegal, and a nurse case manager who represents another intermediary.

Equally as often, the patient has a distant or strained relationship with their authorized treating physician (who, in turn, may have been replaced one or more times during the course of care).

So we now have a patient who has incomplete understanding of the process by which settlement occurs. They fail to appreciate that their physician has nothing further to offer and that residual limitations are either going to span a considerable period of time or will be chronic/permanent.

This is the most common scenario for the patient, who:

a. Becomes aware, almost indirectly, that little or no further change in condition will occur, and office visits become widely spaced.

b. May attend hearings, mediations, depositions, etc. which provoke anxiety and often resentment.

c. Sees this process as all too real and very threatening.

d. Receives very limited information from their attorney, who is involved in document gathering.

e. Is often deeply in debt with no future occupational plans and has a weak sense of how financial survival will occur.

f. Retreats discouraged, fearful and angry

g. Has spent the last few or more years as a “patient” not that of a worker

h. Begins to struggle against the settlement process due to future uncertainty, and with the conviction now that “no one understands nor cares.”

If the patient is concurrently in psychological care, then this retreat can be halted and the patient directed to move in a constructive direction. Clearly, most injured workers, even those depressed and/or in pain, are not in psychological care. I see this repeatedly in my patients as they become an unwitting partner in the settlement dance with no one explaining the timing or the rhythm of this process. They know how to be a patient, but those three letters, “MMI”, suddenly changes how they are seen by all involved in their care. And indeed, MMI is often confused with being well, when in reality it only means that things will not get better.

That is a frightening concept for anyone to confront.

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