While many, if not most, injured workers have severe financial problems that threaten their security, there are numerous cases in which the individual does not wish to return to work: a. The family has begun to compensate for the financial difference, and, with social security benefits, it may not be mandatory that the patient again works. b. The patient may have formed a new relationship that promises financial security, and re-employment is no longer required. c. Choosing between poverty level existence or working long hours in pain, some will make a choice to avoid the pain. d. Many injured workers have performed manual labor since age 16 or before, having had little time with their family, and this may be the first opportunity for some semblance of a family life. e. They reside in a community (or family) in which disability is not uncommon, and they receive considerable support and encouragement ...
I recommend, and routinely assess the intellectual functioning of injured workers. There are two problematic groups for which intelligence plays a major role: a. Those injured workers of significantly subaverage intelligence not only may fail to understand their condition, treatment options and risk/benefit of surgery, but they may also lack the capacity to formulate questions to obtain the data they need. Post-surgically, they may complain about pain but be unable to have their fears/concerns assuaged by the explanations provided them and/or fail to understand their post-surgical treatment regimen (medication, physical therapies and objective limitations). b. Those injured workers of significantly above average intelligence may find the del ays inherent in their care, the awaiting for approval of treatment, and the lack of extensive patient education to be frustrating if not threatening. For those in the former group, it may take ...
It is quite common to see patients who have a high school diploma, or say they do, and yet be unable to understand spoken and/or written information. Many patients will say that they have a high school education because they quit school in the 9th grade and later obtained a GED. Or they indeed completed the 12th grade but were almost 20 years of age and had repeated two or more grades while in school. And even with a high school diploma, even earned by age 18, there are numerous patients that simply have reading limitations. In my own practice, I screen for reading, spelling and mathematical capacity of patients awaiting surgery. There are individuals with greater than high school education that cannot incorporate data that is intended to be at an 8th grade level. Not only their ability to receive new data is of concern but also their ability to communicate a complete history needs to be considered. ...
Candidacy for psychotherapy is a critical factor to have measured. While psychotherapy can be a powerful means of dealing with painful aftermath of injury and a very effective means of dealing with anxiety and depression, it may not be appropriate for specific patients. Patients who come from a family or cultural background in which psychological complaints are considered weaknesses has been discussed before, but there is a larger group of patients in which talking about emotions and inner thoughts is strongly discouraged. These patients believe that they are to deal with such concerns privately; they are not to share them with others. When such patients, in desperation, enter psychotherapy, two negative outcomes may emerge: a. They may become so threatened by what they find themselves thinking, feeling and verbalizing that they withdraw from treatment completely or b. They may become pathologically dependent upon their ...
Most depressed patients will say that “something is wrong” but will also state “but I do not think I am depressed.” They will go on to describe changes in appetite, significant weight changes, forgetfulness, irritability, problems with concentration, decreased libido, pessimism, self-doubt, early morning awakening, agitation, loss of interest in their hobbies, desire to be alone, impatience, low frustration tolerance and numerous other symptoms that, when combined, indicate clinical depression. However, if a person has a need to be seen as depressed for some ulterior motive, they can learn to parrot those symptoms on demand. This is where formal, standardized psychodiagnostic assessment is critical. There are checks within these instruments of the validity of complaints made by the individual. Although it is possible to suspect that an individual is depressed based upon a clinical interview, the psychodiagnostic tests are need to confirm this as a diagnosis. ...
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