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Injured Employees and the Psychology of the Right Treatment

Wednesday, July 9, 2008
Written By
Kory Wells

by Frank Pennachio, WorkCompEdge Blog Contributor

As I suggested in last week’s blog and several of you commented to confirm from your own experiences, the so-called “bad employee” – one who is intentionally milking the system – does NOT contribute to work comp costs and problems as much as we might like to think.
Today I’d like to explore one of the myths of a bad employee, and that’s an employee who gets caught in the wrong treatment plan.
trepanation procedure in the 18th century

Trivia for your next game show appearance: The process of drilling a hole in the skull is called trepanation and has been around since Neolithic times. (18th century image from Wikimedia Commons)

If you had a headache several hundred years ago, your friendly neighborhood medical practitioner might’ve drilled a one inch hole in your skull to let out whatever was causing the pain. If you survived this treatment, surely you never complained of a headache again, even if it was worse! If you didn’t survive, the practitioner believed you died from whatever was causing the headache, not the cure, so he went on to treat the next patient this same way.

It’s easy to laugh at this example from the history of medicine, and delight in the many scientific and medical advances since then. However, the more things change, the more they remain the same. As new technology, pharmaceuticals, and medical methods are introduced at a rapid rate, the potential for their overuse and abuse seems to grow, too. Here are two examples:

According to this USA Today article, medical treatment of back pain costs about $25 billion annually, and workers compensation costs add another $25 billion. Yet best treatment for back pain remains elusive and highly debated. Some patients undergo surgical procedures that studies have shown demonstrate little effectiveness and have considerable risks. Other patients are on long term opiates that were intended for cancer patients in their last days. These treatments prevail while new studies show that behavioral and psychological treatments can be more effective. (See the article The Psychology of Back Pain for some interesting reading.)

Depression in an injured employee is both common and quite understandable: the employee has the psychological load of the physical challenges of the injury as well as the myriad of social issues of being out of work, being dependent on family members, etc. But how often does the injured employee end up on pain meds AND antidepressants? In recent years, there’s been debate in the media about studies showing that antidepressants prescribed for mild depression are no more effective than placebos. Other studies have shown that a walking program is far more effective for mild depression than any pharmaceutical.

Like most of us, injured employees with physical OR psychological pain will do almost anything to make the pain go away. When the treatment is authorized by someone in a white coat, when it involves a pill that’s advertised on TV or in their favorite magazine, and when the insurance company will pay for it, then it must be a good thing, right?

Don’t get me wrong – I’m not blasting doctors or insurance companies or anybody else, but I am questioning the system, and I am questioning what we in the work comp system – whether we’re employers, insurers, or medical professionals – can do to better anticipate and cope with the challenges our injured workers face.

Let me know what you think. Does your experience support my suggestion that treatments through the work comp system are sometimes no better than a hole in the head of our injured employees? Do you have a return-to-work program that acknowledges the psychological aspects of pain and injury? Does mental health need a stronger footing in the work comp system? Do you have a wellness program that addresses depression?


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