Often a patient is forced into a semi-skilled or unskilled occupation due to criminal history. Thus, we see patients of above average intelligence, injured with no willingness to return to that line or work or even that employer. Why? The patient never wanted to work in such a setting but had no choice after release from jail/prison. They may be intellectually skilled and lacking education (or other credentials) to permit them employment commensurate with their intellectual potential. Secondly, an individual with a history of DUIs, possession and/or sale of drugs, may be a decidedly complex case to manage when someone is considering medicating them with narcotics. Simply asking the patient “have you ever had a problem with drugs or alcohol,” the response will be “no.” As one patient remarked: “he (the doctor) asked me if I had problems with drugs and alcohol…I said “no”…it was no problem…as long as I could get some.” Finally, a patient with a broad and consistent ...
I referred to it as “an in vivo mini-functional capacity exam,” and a side benefit for a Psych-IME. As important as the results of a Psych-IME may be, the response of the patient to the scheduling and completion of the exam is also critical. Patients who resist (anger and/or failure to show for) the exam, and obstruct it, are attempting to hide information. Also, a patient may be told that he/she cannot sit for any more than very brief periods and, as a result, the patient is disinclined to consider transitional—duty work options, stating: “they want me to sit at a desk but even riding in a car for ten minutes is impossible.” However, most of the patient sent for psychological IME, pre- or post-surgical exam, or for an initial psychological opinion, travel two hours to this office. They are then in the office from 4-6 hours, and then they drive or ride two hours in order to get back home. Many/most of these patients ...
The developmental history of an injured or ill patient is critical for many reasons. 1. If the patient comes from a family with disabled parent(s), there has been role modeling early in life for acquiescing to the disability role. 2. If the patient’s marriages were unstable, the patient may have continuing instability and inconsistent support, both emotionally and financially 3. If the patient’s developmental history is characterized by poverty, adaptation to the low benefits inherent in workers’ compensation may too readily occur. 4. If the patient did not have a same sex role model who had a specific career or record of productivity, the patient’s expectations for/from a career may be quite low. 5. If the patient was a victim of trauma, abuse, abandonment or neglect, he/she may carry not only the trauma but the resultant distrust into situations that involve authority (Eg. Employers, doctors, insurers, etc). 6. If there was a family history ...
From a physical standpoint pain and depression share much of the same biochemistry of the brain. Equally as important, they both interfere with sleep. The medication taken for pain also often disrupts sleep. The inability to control pain leaves a patient with a sense of helplessness, and from a psychological standpoint, the learned helplessness is the cornerstone of depression. Additionally, knowing that a patient is powerless even to sleep-away-pain, leaves the patient feeling powerless and out of control. The patient will then nap during the day due to sleep deprivation at night. Since narcotic pain medication can result in unusual, if not bizarre, dream content, it is not unusual for pain patients to have nightmares in which they are being harmed or otherwise physically suffering. Thus, sleep and pain become entangled. Upon awakening, they are still tired, and left with the aftermath of unpleasant dreams ...
Most injured workers are in an environment where there are not true light duty positions. These positions are (often reluctantly or certainly unskillfully) created by their employer. Such transitional duty may be sitting at a desk, inactive and bored or monitoring an entrance to the building, in public viewing but social isolation. These types of “transitional” work place the patient at risk for two things: a. exposure to criticism by coworkers who resent the patient being paid for essentially non-productivity, and b. the patient’s own sense of humiliation at being disabled from doing his/her defined role. I have found that injured workers, who continue (or return to) a light duty position, often become anxious and depressed. They lose faith in their employers, their coworkers and themselves. They anticipate that they will be fired, fear that they are resented, and they focus more upon their physical complaints as justification for being in that role. ...
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