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Atlanta Medical Psychology
The clinical practice of Dr. David B. Adams is located in The Medical Quarters in the northside of Atlanta at the junction of Scottish Rite, Northside and Saint Joseph's Hospitals. Dr. Adams consults to occupational medicine, surgeons, nurse case managers, insurers and employers regarding the psychological impact of work-related injury and the role of psychological factors in short- and long-term disability. 

 

Psychological Aspects of Disability

 

Psychological letter
April, 1997

Sociologists refer to a period of economic prosperity and occupational commitment among workers that began between the end of World War II and the end of Korean Conflict.

This period of vocational investment created a perception of careers, employment and the nature of the workforce that maintained an idealism and work ethic within America that spanned >20 years.
This idealism implied to the American worker that:

  • the employee was seen by the employer as a family member

  • the employer could financially afford, and would, protect the employee's job despite any economic downturns

  • the employer would maintain ownership, display pride of ownership of the company, and that sale of the company was improbable if not inconceivable

  • employee's  retirement benefits were unassailable and assured

  • the employee's health and safety would be a primary concern for which the employer accepted complete responsibility

From that idealism of American business and industry arose the workers' concepts of  what truly constituted work. It also defined notions of financial expectancy, concepts of entitlement, investment in employer trust, reassurance of job longevity and ultimately job contentment.

The Intrusion of Reality

The period of idealism eroded when acquisitions and mergers of companies became commonplace, when economic competition from abroad created seemingly irrevocable downtrends in the financial structure of businesses, and where downsizing became the buzzword even for employees who were within few short years of retirement.

Jobs held for decades were made obsolete by new technologies, competition for fewer jobs demanded more from existing employees, and buyouts, early retirement and late-life unemployment became commonplace.
The employer was no longer seen as a source of comfort and nurturance but a distant, aloof, off-times threatening, and seemingly detached, entity.

Business as Usual

Illness and injury among employees was no longer managed informally. Management of personal illness and work-related injury was assigned to specific process and protocol both in reporting and in treatment.
The employee had now limited selection from confined panels of healthcare providers, and the providers participating in that managed care marketplace now had less time with patients and less continuity of care with the same patients.

Impact Upon Disability

The willingness to return work following an illness and injury, the capacity to endure residual symptoms and complaints, and the tolerance of discomfort and/or limitations, cannot be explained solely in terms of the workers' objective physical findings.

While we accept that drive, ambition and determination influence the prowess and success of athletes, we are less likely to examine the impact of motivational factors upon the speed of recovery and the workers' perception that rapid mobilization is something currently praised and rewarded.

Motivational factors including the emotional urgency to return to work, the need for achievement, the sense of commitment to the job, wane when the worker feels that the nature of the job has changed. The factors that impact the rapidity of return to work also include:

  1. the aftermath of illness and injury (how employer and coworkers responded)

  2. the nature of the job to which the worker must return (whether it is in a state of transition)
    the current constituency and anticipated change in ownership/management of the business

  3. what the employee perceives will be ultimately the gains accrued from returning to this employer

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