Some patients behave as though their injuries are some form of melodrama…as though they are performing… This seems to be a contradiction, either they hurt or are suffering or they are not and are enjoying their role. Histrionic individuals can be injured. Injured individuals may become histrionic. The dramatics, theatrics, rapidly shifting and shallow moods, the need to be the center of attention, the continual use of complaints to draw attention to themselves, and exaggerated emotionality can become a hallmark of post-injury behavior. These individuals derive secondary gain in the form of attention, affection, special considerations in their family/social group and are financially remunerated for their complaints. From a clinical perspective, they can also be quite suggestible, and respond in the affirmative when asked about even obscure/unlikely symptoms. They are frequently provocative if not outright seductive in behavior ...
Ideally, you know what kind of pill you are giving the patient, but do you know what kind of patient is taking the pill? It is erroneous and dangerous to assume that because a patient eagerly takes Oxycontin that he/she is a good candidate for the drug. For example, like many narcotic pain killers, Oxycontin can/does produce mood, sleep, anxiety and cognitive changes. Patients in pain sleep poorly, not only quantity of sleep but quality of sleep. What is the impact of Oxycontin on sleep architecture? Certainly the drug can produce drowsiness, but does it permit effective sleep…and what does the patient do when deprived of sleep? Often, they take more Oxycontin. Additionally, what is your goal in the use of the drug? Is it to permit the patient reasonable pain management while he/she learns ways of coping with the pain without narcotics? Or is the medication prescribed, the patient merely warned not to take more than prescribed and then ...
All psychophysiologic issues are of great importance. Let’s set aside someone who has sustained a pancreatic injury at work and cannot produce insulin and look at the more difficult cases to understand/fathom. If you do not have a psychological exam on this patient, and he/she is depressed, sleep will likely be disturbed. It has been shown Americans are getting less sleep. With less sleep comes the production of substantially less insulin. If the individual is depressed, they may well be getting less than the mandatory 7+ hours of sleep. If the individual is in chronic pain, he/she may be getting less than the mandatory hours of sleep, and/or if he/she has marital, financial or family pressures, he/she may be obtaining less than optimal hours of sleep. Once again, all of this has been associated with onset of Type 2 Diabetes. Further, if you do not have a psychological exam, you do not know if the patient is exercising, ...
The spouse of an injured worker can bring additional and complicating barriers to management of an injury. a. The spouse resents that the full burden of the household now falls upon them b. The spouse blames the physician(s), nurse case manager and adjustor for the burden that is now upon them c. The patient permits the spouse to assume responsibility for everything from filling out a history form, to tracking medication, to interfacing with the insurer and providers d. The spouse is often blamed by the patient for the burden now facing the household e. The spouse assumes full financial burden, yet the patient may concurrently demand that the spouse not work and transport the patient to all visits. f. While assuming full burden, the spouse is provided no physical affection nor verbal appreciation Often the couple/family has lived an emotionally and financially ...
Likely there are inappreciative and/or unmotivated patients, but many also present with “conditioned helplessness.” “Conditioned Helplessness” can be at the core of many patient management problems. The patient is doted upon by a well-meaning spouse and becomes increasing dependent and decreasingly motivated. The patient is told not to attempt to find employment and to “just wait,” and this formerly hard working individual now spends days inactive, overeating, and failing to look at future employment options. The patient’s “conditioned helplessness” is exacerbated by receiving financial compensations for weeks, months…years in the absence of a work demands, work schedules and competing in the workforce. The patient was not able to determine the schedule or order of care; this is done by his doctors, and he has become conditioned to be passive, dependent, indecisive…helpless. “Conditioned Helplessness” ...
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