What is it that happens as cases begin to span many months, if not years…what are these patients looking for? As time passes, patients do not become more acceptant of their limitations. Quite often, their resistance to accepting permanent and partial disability increases. They see their financial, marital and social situation deteriorate. With the passage of time, they perceive that they need more and different care, not less, and they need more financial compensation, not closure. Also, not surprisingly, their financial and marital plight worsens. The problem originates early in case management. When a patient is post-surgical and clinically optimal, yet care is continued because the patient continues to have pain complaints, the patient becomes conditioned to a series of new trials, new attempts, and often a procession of physicians. Their life becomes a schedule of various visits, therapies and often a drug regimen that ...
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 ...
You have two claimants with identical injuries and equally adequate care – one works hard to get back to work, and the other fails to recover or actually works against recovery - - the differences between these two claimants may well be psychological. You can, therefore: a. Order a psychological examination to determine why one of the two elects not to recover b. Allow the psychological factors to drive the case but fail to investigate and determine what those factors are The psychological foundation for failure to recovery exists even if you try to ignore them. Research indicates that a thorough psychological exam tells us why a patient is not mobilizing. By doing so, it alerts those involved in the patient’s care so that they know how best to proceed. A thorough exam tells them how to manage the situation. It is very uncommon for these claimants to seek psychological care. It is not part ...
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? ...
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