As they proceed toward settlement, an injured worker, at the very last moment, suddenly asks for another opinion, a change of providers or some other obstacle toward closure. Why do they consistently do this, and can it be predicted?” I am tempted to reply with “what else are they supposed to do?” What I mean is that very often these individuals have nothing to do once their “case” settles. They know that the money will not last, and they have established no future plans. After 1-3 years of living as a workers’ comp patient, they have little other meaning or direction to their lives. As anyone approaches a goal, the closer you get, the more anxiety you experience. This is why people fail to show for their own weddings, or why they back out of closing on the purchase of a home. Closure implies a commitment and acceptance of its long term implications. Closure is frightening for some individuals. Yes, it can, indeed, be ...
After surgery, patients complain of chronic pain. They are kept on narcotics, and there are no measures available. THey are then referred to one of several pain clinics. This is a major concern. If the referral to a pain clinic is meant to be a discharge of the patient, it is not interpreted that way. The patient expects that when/if the pain center does not resolve the pain, the patient will return to see you. If you have nothing more to offer the patient, you need to state that, release the patient MMI with a PPD rating. Some patients, unfortunately, will have chronic pain for which there is currently no resolution. Secondly, patients in pain do not sleep well when prescribed narcotics. They become habituated to the narcotics, their sleep architecture is impaired, they awaken during the night, they are in more pain when sleep deprived, and they are reactively depressed. There are antidepressants that, even in low dosages, assist with establishing normal ...
You need a psychological examination of the patient to determine if they are a candidate for psychological care, but is this the only time a psychological evaluation is needed? It is true that treatment cannot proceed without diagnosis. It is also true that a diagnosis cannot be made without examination. However, the vast majority of patients seen are not referred for treatment. Most are referred because they are failing to recover. They are being provided with adequate post-injury care, but either there is no change, or their complaints are worsening. There are numerous psychological factors that can contribute to this. Some of these are withheld by the patient. Others are outside the patient’s immediate awareness. All of these factors conspire to block the patient’s recovery. Sometimes these are referred to as “treatment resistant patients.” Often they are not resistant to injury care, their true needs and fears are merely ...
Clearly, this would seem not to be a clinical matter, merely a financial one. But I suspect that early settlements occur because an insurer or employer has found case management to be burdensome, unrewarding, unending and often punitive. Many insurers and employers perceive that ultimately the patient and his/her family solely want a monetary conclusion. While this may be true in some cases, my clinical experience is that insurers/employers (including adjustors/nurses) are not able to discern the patient’s goals and try to find a dollar amount that allows closure since the underlying goal appears elusive. Many patients want the unachievable: they “just want things back the way they were” (pre-injury status)… “want my life and my family back” … “want to go back to the work I did.” These often unattainable goals are often unrecognized and, therefore, never addressed. The patient languishes, all become frustrated, and the money ...
Monday, November 5, 2001. A personality disorder is a developmental defect. It is an enduring and inflexible pattern of behavior that effects social and occupational functioning. A personality disorder impacts the way the claimant perceives himself, events and others (cognition), his range, intensity, appropriateness, and lability of mood (affectivity) and it influences interpersonal functioning and impulse control. Since ~50% of claimants may suffer from a personality disorder, knowing which disorder has influence over their behavior enables us to understand, predict and ideally control any inappropriate behaviors that arise. Thus, if we know a patient is a (socially) avoidant personality, a paranoid personality, a dependent personality, a negativistic personality or an anti-social personality…or even an amalgam of several personality disorders…we are able to predict how the claimant will respond to the stressors and demands ...
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