1	Managing the New Culture of Disability
2	Seminars & OnLine Exam at www.psychological.com
3	"Atlanta Medical Psychology" Atlanta Medical Psychology
4	Seminar Concept Difficulty
5	Employee Risk Management The UPC Code Understand behavior of injured workers Predict workers’ response to care Control costs, outcome and impact of employee dysfunction If time permits, Questions & Answers
6	The Deleterious Impact of Pseudoscience & Psychobabble Recent research on testosterone, etc The lack of individual accountability The seeking of disability status The media “experts” The public is dependent The public is ill-informed The public cannot evaluate credentials The “diseasification” of life’s events
7	Know Your Statistics 18-22% of the general population has symptoms of one or more psychological disorder Lifetime prevalence of psychological disorder may approach 25% 80% of those in need will never seek care 5% of surgeries may be due to purely psychological symptoms 10% of adult Americans suffer from a Personality Disorder All these figures are significantly greater for injured workers
8	Georgia Case Demographics Most injuries occur in semi-skilled, intensive labor positions, requiring overtime for financial stability with an absence of career or economic plan. Most have no viable future plans, economic support, and do not fully understand injury or treatment options. Most have marginal education and training; many have subaverage intelligence Many have unrealistic expectancies of treatment or case outcome. Most lost time cases have agenda that complicates or obstructs the course of recovery. Many, many have problematic marriages and families which include substance abuse, disabled family member, complicating health problems and severe financial problems.
9	What Makes Us Tick: The BioPsychoSocial Model
10	Neurobiology of Mood “it’s all in your head”
11	Brief Symptom Checklist of the Depressed Employee Employee lost or gained significant weight? Employee complains of specific sleep problems? Employee is irritable? Employee is forgetful, has difficulty concentrating and/or has trouble making decisions? Employee feels guilty and/or worthless? Employee readily becomes tearful? Employee ceases to enjoy hobbies or interests? Employee has had a decrease in libido? There is psychomotor agitation or retardation? Employee expresses thoughts about death?
12	Overtly vs. Covertly Psychological Overtly Psychological Claims of Mood or Anxiety Disorder Claims of Posttraumatic Stress Disorder Claims of Pain Disorder Covertly Psychological Anger & Resentment Suspicion & Distrust Entitlement & Deservedness Denial of Pre-existing Problems
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15	Factors Extending the Duration of Injury Complaints Misperceptions of injury and objective findings Use of injury complaints to manipulate others Use of complaints to resolve life’s problems Our culture of entitlement
16	Employee Management Myths Employee will go back to work as soon as the treating physician says he/she is able Employee complaints are accurately measured by lab tests You can successfully coerce an employee back to work Honest employees always behave rationally Employees have more problems than doctors
17	Understanding The Psychology of the Worker
18	Family & Societal Factors Contributing to Disability Claims Dependency Family Reinforcement Financial Remuneration Need for Retribution Fear of the Future Educational Limitations -> Occupational Inadequacy Intellectual Limitations
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20	The synonyms for “Psychological” as found in medical reports Functional Overlay Conscious Embellishment In excess of objective findings Non-physiologic Indicators Symptom Amplification Inconsistent Effort Secondary Gain Faking/malingering
21	Malingering Goal is tangible gain, chiefly financial. Voluntary production of symptoms Symptoms sometimes bizarre Is not a disorder but simply manipulation
22	Malingering takes many forms… Pure Malingering Partial Malingering Malingering by Assimilation Malingering by Dissimulation Malingering by False-Imputation
23	The Anti-Social Model Employee sees this as an economic opportunity. He may have engaged in similar behaviors in the past He is unrepentant His goal is financial and to gain control of those about him
24	Psychological Overlay: Truly Valid Concerns Will add to the cost of care Will add to the cost of settlement Will add to the PPD rating Is a manipulative ploy Will not be competently diagnosed Will not be competently treated Will treat pre-existing/unrelated issues
25	Psychological Exam is Needed in: Assault Cases Amputation cases Chronic Pain & Depression Surgical or Procedure Candidacy Suspected Medication Misuse Questionable Surgical Outcome Procedural Candidacy When Complaints Exceed Findings When There is a Criminal History When There is a Prior History of Injury Claims When Employment Prior to Injury Has Been Brief When There is a Catastrophic Claim
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29	Face the Facts: All of life is psychological Psychological aspects of living are not disorders A psychological disorder is not a disability Different is not disabled
30	Bottomline Over time, many treated, injured workers will become increasingly dysfunctional These dysfunctions will affect their willingness to consider a return to work. You cannot ignore problems away “Elective Dysfunction” is increasingly being called a “disability” Human resource departments are not equipped for the degree of psychopathology that appears in the workplace There will be legal repercussions for not addressing problems when first detected, even before injury Insure that your company has access to a consulting psychologist, and know his credentials…
31	Summary