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2	Avoiding Psychological Claims: The BioPsychoSocial Model
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4	Myths Patient will return to work because treating physician says he/she is able Pain is a quantifiable measure best tested by an MRI You can coerce a patient back to work by denying or suspending benefits and other acts Honest patients behave rationally Patients have more problems than doctors
5	Facts: A Psychological Disorder is not a disability All Claims Have Psychological Components Failed Resolution Often Arises from Case Mismanagement There is no morning after pill for men.
6	Psychological Disorders 18-22% of general population has symptoms of one or more psychological disorder 80% never seek care 5% of surgeries may be due to psychological symptoms >60% of back injuries have pre-existing or injury consequent psychological disorder 50% of back injuries (especially MVAs) have symptoms of PTSD.
7	Psychological Statistical Review Most injuries occur in semi-skilled, intensive labor positions, requiring overtime for financial stability with an absence of career or economic plan. Most have no viable future plans, economic support, and do not fully understand injury or treatment options. Most have marginal education and training; many have subaverage intelligence Many have unrealistic expectancies of treatment or case outcome. Most lost time cases have agenda that complicates or obstructs the course of recovery. Many, many have problematic marriages and family including substance abuse and disability, other health problems and past/current bankruptcy
8	What Are The Causes of Psychological Claims (A Multiple Choice Exam) Fraud & Deception Algaecide Needed in Gene Pool Inherent Nastiness of Panel Providers Sadomasochistic Trends in Adjustors Attempts to Please the Employer All of the above
9	Obvious Mandatory Psychological Exam Assault Cases Amputation cases Severe Burn Cases Extreme Unrelenting Pain True Catastrophic Injuries Suspicious, bogus, and inexplicable claims
10	Critical But Less Obvious Reasons for Seeking Psychological Data Procedure Candidacy Suspected Medication Misuse Questionable Surgical Outcome When History of Multiple Injuries When Employments Have Been Brief When There is a Criminal History
11	Why Exams are Postponed Afraid of Offending Insurer Physician Employer Lack of Clinical Sophistication The “duh?” factor Perceptual Bias Psychological problems are nonsense or weakness Psychological problems are expensive Psychological problems are tools of the devil
12	"Mood and Anxiety Disorders naturally..." Mood and Anxiety Disorders naturally arise from serious injury Employer, Insurer, Physician unnaturally trigger anger, confusion, despair and frustration in injured workers Developmental/Longstanding/Pre-existing/Family Disturbance are opportunistic Sense of Entitlement
13	Psychological Red Flags
14	"Disability in Family" Disability in Family Past Emotional Trauma Learning Limitations Economic Background Past Litigation Marital History Medical History Occupational Path Perceptions of Current Condition
15	Data Impacting Outcome The Patient’s Recounting of the Injury and its aftermath The Patient’s Perception of Quality of Care The Patient’s Underlying Needs and Goals
16	"Patients may resist psychological examination..." Patients may resist psychological examination (cultural) Naïve young, and rigid old, adjustors will resist psychological examination Attorneys fear psychological examination Chronic Pain Profile merely delineates why symptoms are occurring Chronic Pain Profile does not recommend treatment, delineates why physical symptoms exist.
17	"Have a concept of the..." Have a concept of the biopsychosocial model (injuries are a great deal more than tissue damage) Make certain panel physicians are not your unwitting enemy. Make certain adjustors are not inadvertently case-building while thinking they are case resolving Be certain physicians and nurses anticipate psychological overlay (not ignore it) Be certain employers (managers, supervisors, and coworkers) do not build cases through injured-worker-isolation. – Educate Your Company
18	"This will leave you clarified" This will leave you clarified, enthusiastic, and determine You will rush back to your office and implement many plans You will find your determination wane You will return to your old patterns of behavior You will now find an irrepressible urge to e-mail me your credit card numbers including expiration date and 3 digit code on the back
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