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Case Management Update
This Week's Topic: “Diagnostic Failure“
Question: "His brief psychological report merely said that she was depressed because of her injury."
Dr. Adams replies: "If a patient has pain, the authorized treating physician uses diagnostic tools and therapeutic approaches to treat the symptom. The patient does not determine causation, treatment, prognosis, or disability, and may be unaware of degenerative disc disease or a past partially torn rotator cuff.
Similarly, the patient may tell the psychologist that:
a. I have never been depressed beforeb. My depression arises from this painc. I cannot function at my job or return to my job while I am this depressed.
All of those statements may be factually accurate. However, they do not include critically important data such as negative events preceding, surrounding and following injury. Depression may be felt as an emotional substitute for anger, frustration, fear of abandonment or a sense of future despair. If the individual is unaware of these underlying issues, they will not include them in their self-assessment. Importantly, they will not be included in a cursory psychological report.
Thus, we inevitably return to the importance of a formal psychodiagnostic assessment to determine not only the veracity of the patient's beliefs, but other factors that are preventing the patient from mobilizing.
Unquestionably, there are inadequate psychological reports in which the patient's problems are birthed at the moment of injury. No other information is sought: the patient is injured, in pain, depressed, and that's all anyone needs to know.
This is sadly incomplete, inaccurate and arguably dangerous since we do not know the lengths to which the patient, or family, will go in order to cope with the injury.