We often see husband direct the course of care and obstruct any meaningful progress for the injured wife. Equally as often, we see the wife over nurturing this big and robust husband whose injury is modest but who loves all the attention. I strictly enforce the policy that the spouse is not permitted in the room while I am examining the injured worker. It is very, very common for the patient then to reveal the role that the husband (or wife) is playing in the injury. For a psychological exam, it can be revealing as to whether: the patient comes alone or the spouse sits for six+ hours in the waiting room and/or the spouse keeps asking staff questions the spouse makes unrealistic demands on breaks the spouse interrogates the patient the spouse wants to offer data about doctors, insurers, case managers, etc the spouse dispenses medication ...
Let me summarize an article by Dr. Stephen G. Gelfand, rheumatologist. It is lengthy but very well worth taking time to read this summary: “A serious medical and social problem today is under intense media, law enforcement, and regulatory scrutiny: the misuse and abuse of OxyContin (oxycodone) for chronic nonmalignant pain… In addition to recent Drug Enforcement Agency (DEA) autopsy findings of nearly 300 OxyContin overdose deaths nationally since January 2000, a large volume of patients with chronic nonmalignant pain have become dependent or addicted as a result of legitimate prescriptions written for OxyContin, as well as other opioids… In a recent case, the DEA suspended physician narcotic licenses and closed a South Carolina pain clinic for the excessive prescribing of OxyContin, although the physicians involved believed they were following current established standards… How did this situation occur? In the first place, certain …narcotic ...
3 Related Questions: 1. From a claims adjustor: “A surgeon has put one of our claimants on Elavil. Do anti-depressants help the injured worker, and how much of this depression are we stuck with?” 2. From a physical therapist: “One of my clients is tearful in every physical therapy visit, and when I asked him if he were depressed, he said that he was…I think he needs medication.” 3. From a nurse case manager: “How do I differentiate between injury as a cause of depression and all the craziness that is going on in this patient’s personal life?” First and foremost: is the patient truly depressed? And has this been validated with diagnostic testing or simply assumed based upon the patient’s (or someone else’s) statements. Unless clinically validated using recognized diagnostic testing, then all we have is a subjective impression that the patient “might” be depressed. He/She could just as easily ...
There are numerous reasons why a patient does not return to alternate/light duty employment: a. Does the patient believe that they are being incompletely or misdiagnosed and that they are being sent back to work by someone incompetent to know what is truly wrong with them? b. Does the patient believe that returning to any form of work run the risk of re-injury? c. Does the patient believe that returning to any form of work will reduce the amount of their cash settlement? d. Is the patient angered at the employer (and/or coworkers) and feel that not returning to work will punish the employer? e. Does this light duty work place the patient in a position where they fear they will be resented and ridiculed by harder working coworkers? f. Will the employer truly comply with the work restrictions or slowly force the patient to engage in tasks that exceed objective limitations? ...
Injured Workers Who Believe They'll Get Better, Do Better The power of thoughts like "I think I can, I think I can ..." may extend well beyond nursery rhymes. A study shows positive thinking can help injured workers recover from their injuries faster and get back to normal activities. The study, published in the Canadian Medical Association Journal, tracked the progress of more than 1,500 injured workers after they filed a claim for their injury with the Ontario Workers' Compensation Board. Researchers questioned the workers at regular intervals about their recovery expectations for a year after the claim. They found factors such as the injured workers' perceptions about progress to date, expected change in condition, and expected length of time to return to normal activities were major predictors of how soon and how well the workers recovered. "Our study provides further evidence that patients' expectations ...
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