When a patient seems depressed or when the patient indicates he/she feels she needs assistance, that is the time to consider a psychological examination. Similarly, if the primary provider, a surgeon for example, feels that it is indicated, it should be pursued. However, the point at which one need to consider a psychological examination is when the patient’s injury complaints have continued beyond that which the objective clinical findings would indicate. Thus, if 30-60-90+ days after injury, and current clinical findings indicate the patient should be capable of returning to work, but the patient continues to complain of symptoms and resist return to work, psychosocial factors are at play. These psychosocial factors will not subside. They most often become entrenched and/or expand. While 2nd and 3rd opinions as well as more physical therapy and new medications are being sought, there may be no change in the patient’s willingness to mobilize. ...
It is cheaper for us to just medicate a patient rather than pay for even short term psychotherapy. Is not the prevailing opinion that pills are not only effective but cheaper? Many strongly believe and advocate medication, stating it is faster, cheaper and more effective. However, this is in contrast to some recent research findings. A recent address at a mental health conference cited the consistent findings that cognitive therapy and antidepressants are equally effective for initial treatment of severe depression, but the enduring effect of cognitive therapy may prove to be more cost-effective in the long run. Sixteen weeks after treatment, response rates were identical (57%) for both drug and cognitive therapy treatment. In one study, 75% of patients who received cognitive therapy avoided relapse, compared with 60% of patients receiving antidepressants. The effect of a brief course of cognitive therapy was better than a similarly brief course ...
Injured workers are initially very aggressive in their compliance and urgency to return to work, but once they reach ~9 months post injury, they slow down, and after a year or so, it is difficult to move them forward regardless of injury. Too much time and too few perceived options are at the core. For the first year, an injured worker may belief that rehabilitation, even with surgery, will be brief. As the bills continue to come in, as the children still have needs, as their mate has to shoulder the financial burden, as their pain continues, they begin to habituate to doing very little with their days. Initially, they do home exercises and help around the house. Soon, they become discouraged, nap during the day, watch mindless TV, and they remain most often socially isolated. They begin to feel guilty, embittered, enraged, fearful and frustrated. This is expressed as irritability. It is not discussed with family or friends, and, indeed, friends ...
An injured worker's suspicion and doubt over the quality of their care is “the crisis of distrust and mistrust.” After an injury, a patient is placed in a helpless position and must invest trust in one or more people to insure that their needs are met. Often that trust is misplaced. Ultimately, the trust needs to be placed in those attempting to treat and rehabilitate the patient. The only healthy assumption is that the patient wishes to, and is motivated for, recovery. However, in reality, family, friends and others, may be invested with trust by patient without actually warranting this trust. There can be those close to the patient who manipulate him/her for their own gain. This gain can be a sense of control over them or the promise of a future financial reward. The patient, in a position of vulnerability, places trust in those who have not earned it, and concurrently distrust those whose efforts would benefit them. A case ...
First let's redefine Munchausen's Syndrome as an individual with (Factitious Disorder with Physical and Psychological) Symptoms that warrant endless contact with the health care system. These patients have a wide range of complaints, involving many organ systems of the body, and they will seek out painful and even dangerous diagnostic and invasive procedures so that this attention seeking process can continue. While this often occurs, and a work related injury can be an opportunity for the Disorder to present itself, there is a greater concern - drug seeking. Is this patient being medicated each time he/she is seen at the ER, and are the medications chiefly narcotics? If you seek out and compile the records, you may find that not only is the patient being prescribed narcotics, but the patient is also reporting "allergies" to all but the most preferred narcotics. Thus, the patient states in the ER that he/she cannot tolerate ...
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