Dr. David B. Adams – Psychological Blog

Psychology of Illness, Pain, Anxiety and Depression

Vice Grip

vice-gripVice-Grip: Within workers’ compensation there is continual pressure to address only that which seems immediately and plausibly related to injury. Any other assessment or treatment plan is denied. Indeed, even those complaints clearly related to injury may be denied, including tests, medications, and procedures.

In this system we become conditioned that if it feels unrelated, then we cannot address the patient’s complaints. In some cases, however, those complaints which are clearly not related to injury may represent extremely serious health concerns.

If a private patient is seeing a neurologist for numbness in his arm and mentions that he is also having digestive symptoms, the urologist will refer him to a gastroenterologist. Just because the GI tract is not his specific field, he appreciates that the patient is having concerning symptoms. He does not say that he is “not authorized to address these issue and ignore” the complaints because he has an obligation to see that appropriate diagnosis and treatment is pursued by the patient.

The converse is true under workers’ compensation. The patient is told that the complaint: a. is outside of the provider’s specialty area and cannot be addressed. b. is not relevant to his care c. cannot be followed by a referral to another office Providers are squeezed to comply with directives that may be made by those with limited clinical knowledge, who in turn may be under the control of companies focused on cost control, even for diagnosis and treatment that could *potentially* be related to injury.

Cost containment can exact severe costs of their own such as the cost of the patient’s health and survival. That is not to say that there are not pressures from the other side of the equation. Providers are held in a vice-grip.

Some may wish for the provider to see a causal link between any and all complaints. “But for this injury” the patient would not be obese, therefore, hypertensive and diabetic.

While one force is demanding that many symptoms be left unaddressed, the other force wants everything included, even the causally improbable. Regardless of from where the external pressure arises, the clinical responsibility is to make note of the complaint rather than pretend it does not exist.

American Psychosomatic Society

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