On workcover and confronted with disbelief by your treating doctor?

doctor-does-not-believe-my-pain

Most injured workers know that it can be very difficult to find a doctor, specialist or surgeon who is willing to treat your work related injury (or illness). It can be even more difficult to obtain a 2nd (and 3d) opinion, and if you are not happy with your treating doctor (i.e. s/he does not believe your symptoms), for many, it is almost impossible to find a new doctor/surgeon/specialist who is willing to take over your care. So what do you do?

Many doctors, surgeons and specialists (medical practitioners) avoid the evaluation and treatment of injured workers (accepting workcover patients) for 3 main reasons:

  1.  some doctors do not like taking the extra time needed to complete the necessary and overwhelming, bureaucratic paperwork or the extra time required to communicate findings to the numerous parties involved in an industrial injury (for which they are often not paid, or under-paid); and
  2. some patients (injured workers) seen in a workers’ compensation setting do not respond to treatment in a predictable fashion, and there is anecdotal evidence that injured workers do not recover as well as those who are not on the workcover system.
  3. The adversarial atmosphere surrounding (contested) workcover claims may incite injured workers to resourt to ‘exaggerate’ their symptoms, because they are confronted over and over again with manifestations of disbelief, hence quite a few practitioners also believe injured workers are “malingerers”.

The second reason noted above obviously presents a dilemma for the medical practitioner, because work injured patients often do not get better with the interventions commonly prescribed for a specific injury. When this happens, enormous effort on the part of the treating practitioner can be required to tease out specific reasons why these workcover patients are not getting better… (We have posted quite a few articles on this subject, including our most recent “The concept of Do No Harm should be applied to workcover“.

Quite often, an injured worker’s failure to improve is attributable to reasons that a treating medical practitioner cannot affect or influence, causing frustration on the part of that doctor/surgeon/specialist. It has been suggested that this is particularly true when an additional report or an impairment rating is required on an individual who, according to the doctor, would improve under other circumstances (for example, a patient who might have improved if circumstances were different with regard to external influences on recovery and return to work).

On workcover and confronted with disbelief by your treating doctor?

However, as noted in the third reason, sometimes the injured worker’s failure to improve, or the injured worker’s physical (and/or mental) deterioration is- in part or entirely- attributable to the treating doctor/specialist/surgeon!

Whilst the adversarial atmosphere surrounding workcover claims may incite injured workers to resourt to ‘exaggerate’ their symptoms, the more they are confronted over and over again with manifestations of disbelief, quite a few injured workers’ treating doctors simply do not (or no longer) believe their injured patients.

One of the most infuriating things you could ever hear as a pretty beaten up injured worker in PAIN is, “I don’t know what’s wrong with you, maybe it’s all in your head…maybe it’s the way you react to pain…” or something alone the lines.

Assessing the extent and validity of the injured worker’s symptoms

Evaluation of workcover cases and as such injured workers requires the doctor/surgeon/specialist to determine if symptoms are real. This process can be very difficult and even tricky. Some injured workers with injuries will under-report their symptoms. Under-reporting may happen when injured workers are desperate to return to (regular) work and therefore falsely state that they are better. Under-reporting obviously places these injured workers at risk for further injury.

On the other hand, some  workcover patients over-report, making their symptoms seem or appear greater than they are.These (c)overtly abused-by-the-adversarial-workcover-system injured sods believe that they must (repeatedly) validate the reason for coming to see the doctor, and some will go as far as wince and grimace with pain with simple, minimal physical examination, out of fear they will be disbelieved.

The medical practitioner who is evaluating the injured worker has to assess the true level of , for example, physical weakness and loss of function, as well as the amount of subjective pain. and any other symptom the injured worker is complaining from.

When you are suffering with pain (or any other symptom of concern) and you ask for help, the last thing you want to hear is that your doctor who is supposed to help you doesn’t even believe your pain (or symptom) is real.

So what can you do, if you think your doctor doesn’t believe your pain (or a symptom), and believes it is “all in your head”?

In an earlier article (When doctors don’t believe your pain) and from our own injured experiences we created a list of things you could consider doing to make your doctor believe your pain is damn real. However we perhaps forgot to add one more important consideration, namely attending the emergency department of a good, tertiary (academic) public hospital!

Case example

Recently a seriously injured worker who has undergone numerous surgeries, including a fairy recent total joint replacement started suffering of increased pain and stiffness in her replaced joint. After having been told to ‘be patient’ and ‘increase/persist with rehab exercises’, the pain still increased. Her surgeon became frustrated with her and started insinuating that she was malingering. Phone calls were made to her husband alleging a ‘problem with coping’, ‘the way the injured worker reacts to pain…’, and eventually the surgeon overtly told both the injured worker and her husband that ‘she was THE problem’ and ‘that she needed to see a psychiatrist’.

The pain in the injured worker’s replaced joint continued to increase and she started to feel ‘flat’. She went to see her psychiatrist and discussed the ‘pain’ issue and whether it was possible to feel such pain ‘in your head’. The psychiatrist who had been treating this injured worker for a couple of years (and knew her well) explained that it is possible to suffer from general central nervous over-sensitisation, which is a bit akin to CRPS (chronic regional pain syndrome or formerly known as RSD), however he felt that the injured worker’s pain was more than just ‘over sensitisation’, given she had undergone numerous surgical procedures without any such symptoms. He recommended she consult with her pain specialist.

The injured worker’s pain still increased and she started to feel generally unwell. At her last appointment with her treating surgeon, she and her husband pleaded with the surgeon, stating that ‘there is obviously something wrong’ with her replaced joint. Her husband stated his wife (the injured worker) could no longer sleep from the pain, was not seeking attention (no doctor’s visits/doctor shopping), that nothing had changed in her home environment, that she was withdrawing (from pain) and that he bore witness to all these symptoms as he obviously lives with her. The surgeon became hostile with both the injured worker and her husband, swore and said loudly and clearly that there was nothing wrong with the injured worker’s joint replacement, and that she needed psychiatric treatment.

At wit’s end, the injured worker just about literally curled up in bed (from pain and humiliation). Days went by and yet the pain still increased and she really felt unwell. She went back to her psychiatrist and even asked him whether the antidepressants were still working as she could hardly get out of bed and felt exhausted. She started to believe that maybe she did have a psych issue, or at best, that she may be one of the few patients who simply don’t get pain relief from a total joint replacement.

Another few days went past, exhausted and in pain she simply spent most of her days in bed…. ruminating and wondering if this was real.

And then she became violently ill with fevers above 40 degrees and rigors, and could hardly move her joint. Her husband was so concerned that he rang an ambulance, as he had never seen his wife clattering her teeth like that and looking so sick. The wife (injured worker) refused to get into the ambulance, by then adamant that “it was all in her head” and that she would be “in any case disbelieved”. Her husband called her psychiatrist and asked him to convince her to attend the emergency department. She eventually did, some 17 hours after she went into septic shock!

At the hospital (large tertiary public hospital), the injured worker was rapidly diagnosed with blood poisoning (aka sepsis) caused by a very infected total joint replacement. She spent about 2 weeks in hospital and was told had she waited another day she would have gone into organ failure!

The staff (doctors, surgeons etc) at the hospital were amazing, she writes. They treated her like a human being (and not a ‘dog’ or some ‘criminal’) and listened to her concerns. One of them was obviously her extreme anxiety of having to see er treating surgeon again, who did not believe her or any of her complaints and let her become this ill.

The hospital assured her that her care and treatment were now taken over by the best orthopedic surgeons at the hospital and that she no longer had to return to see or be treated by her own rude and obnoxious surgeon.

This injured worker is now extremely relieved and grateful to the hospital, not only that her care has been taken over by another (team of) orthopedic surgeons, and that she no longer has to be treated by her own surgeon, but she is also relieved that they found the cause of her severe pain. Whilst more surgery and treatment lays ahead of her, she wanted all injured workers to know that ….

when your own doctor does not believe you, you can -and should- go to the emergency department of a good public hospital! And yes, they can take you under their wing – solving the difficult problem of finding another treater who is willing to take over your care when on workcover.

 



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