Dr. David B. Adams – Psychological Blog

Psychology of Injury, Pain, Anxiety and Depression

Authorization for Care

Authorization

WP_dailysanctuary-com_2015_03_rare034-1-1I would like to discuss authorization-for-care as a general topic; both delayed and denied authorization.

“Learned helplessness theory” is the view that clinical depression and related mental illnesses may result from a perceived absence of control over the outcome of a situation. Patients who have been ineffective in controlling outcome are defined as having acquired learned helplessness. Most healthy individuals either feel, or want to have, a degree of master and control over their environment and outcome.

If merely telling someone (patient) that they “need not feel that way” would change thoughts, emotions and behaviors, human problems would be infinitely easier to solve. But feelings most often do not give way to persuasion; patients cling to symptoms regardless of absent findings, and justify their emotions with the perceived predatory behaviors of others.

Contributing to this is their forced relationship with the authorized treating physician. Their doctors are assigned rather than chosen. And while the patients may not understand why a procedure, diagnostic test or medication is ordered, they believe…hope…that what has been ordered will benefit them. Authorization for the order is controlled by a nameless, faceless individual with whom they have no relationship.

When authorization is delayed or denied entirely without providing an explanation, the patient’s lack of control translates into anger. Even worse, their authorized treating physician can/will share displeasure that the authorization has not been granted. The doctor or staff directly expresses this to the patient in the form of “I cannot help you if they do not permit me to____, and if I do not do something soon, you are not going to improve and may get worse.” While there may a valid reason to deny a procedure or referral, the patient does not have that information.

Most patients referred to my practice are suffering from both pain and related depression and often feel that nothing that they do will resolve the myriad of problems that have arisen (or made worse) by injury. This may be an accurate statement, but it also may be a reflection of frustration which the patient then carries.

Insurers often inquire as to why this patient (vs. another) has symptoms of, and needs treatment for, mood disorder when another patient has the same injury and is not depressed. The difference between these two groups of patients can often be found in the  domino effect of denied/postponed authorization leading to the patient’s  learned helplessness.

 

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