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Work Comp/malingering
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Work Comp/malingering - April 13, 2007 7:43:00 AM
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orthotherapist
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Just throwing this out there for discussion.
Today several clinicians got into a discussion in our clinic about difficult clients/symptom magnifiers/malingerers etc.
What are your experiences about the percentage of clients (specifically work comp/personal injury) that are "playing the system".
My experience (worked exclusively work comp for 6 years) is that very few are truely playing the system but instead are indirectly magnifying their symptoms due to fear of the unknown (i.e. will I have a job, will other co-workers look down on me for missing work, etc, etc) and that if you keep the patietn focused on recovery the outcome is better.
One clinician took the view that a good majority are playing the system while another took the view that there are no malingerers.
Since thoughts were all over regarding this I thought I would post it here
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Re: Work Comp/malingering - April 13, 2007 9:10:00 AM
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treybien
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From: Milwaukee, WI
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As someone who also did exclusively work comp for 6 years I tend to agree with orthotherapist. I had the pleasure of working in the same office as the orthopaedic surgeons, physiatrists and neurosurgeeon. We tried to set very distinct time frames of when the patient should be ready to return to work based on type of surgery, type of injury, and job demands. When the patient gets the same info from both ends I think it helps their confidence. I think this goes in line with the focus on recovery. I also worked with an excellent group of doctors who were very pro rehab which helps.
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Re: Work Comp/malingering - April 13, 2007 9:58:00 AM
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PTupdate.com
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I personally feel over 50% are playing some sort of game.
John Duffy, PT OCS
[URL=http://www.PTUpdate.com]www.PTUpdate.com[/URL]
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John M. Duffy, PT
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Re: Work Comp/malingering - April 13, 2007 10:16:00 AM
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orthotherapist
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Duffy,
Do you feel they are purposefully playing the game? In other words did they start out with that intention when they were hurt or is it quickly ingrained in them due to the system. Stay off work longer - get more $$. Ever noticed how work comp lawyers run commercials during the day when these workers are at home. I once had a patient that did not take care of their surgical incision because as he said "the nastier is looks the more money I get". He was told this by a lawyer and indeed it is true.
I agree the number can be high if not dealt with quickly/from the first contact with medical providers.
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Re: Work Comp/malingering - April 13, 2007 11:33:00 AM
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silverfish
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From: Charlotte, NC
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I work in a clinic with 99% WC patients and would approximate that 75% are legit and 25% are blowing smoke. True sign for me is the mention of a lawyer and an objective exam that does not correlate with subjective complaints. Having said that, I believe that of the 75% with legit m/s injuries, there may be some magnification of symtpoms to extend there time off of regular duty. Those are the people that you put through a tough intense program and they will usually be glad to return back to work
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Re: Work Comp/malingering - April 13, 2007 11:41:00 AM
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PTupdate.com
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From: Pittsburgh, PA USA
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Some may be purposely playing, others may have psychosomatic issues. Either way, the system is being played. I usually try to nip it on the first visit, and if they have any issues about still having to work, even light duty, remind them that in my opinion, if one can breathe, he can work.
Duffy
_____________________________
John M. Duffy, PT
Board Certified Orthopaedic Clinical Specialist
www.PTupdate.com
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Re: Work Comp/malingering - April 13, 2007 6:38:00 PM
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Rwantz
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From: Middletown, PA
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I believe that a very small percentage is playing the system. I think that those that are should be fairly easy to identify (especially with time).
However, I have heard and believe for myself, that if you have even the slightest thought that someone may be malingering, that you should transfer them to someone that will not judge the patient's intentions. If you begin to doubt the patient then you will not have the belief that they are going to improve. This is not fair to the patient and it is not our responsibility to judge them.
If they are not progressing like they should then perhaps an FCE to determine what they can actually do (which will give both parties confidence in where they are) is in order.
Believe in your patients. For the few that are using the system, hopefully documentation and an accurate FCE will reveal it.
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Re: Work Comp/malingering - April 13, 2007 10:13:00 PM
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steve
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Rwantz,
No offence, but isnt that the equivalent of passing the buck? Should the same be done by physicians who believe their patient may be drug seeking for narcotics?
I dont think that malingering is cut and dry - there are usually a multitude of physical and psychosocial factors to varying degrees going on with the majority of patients we see and to pass these patients on to someone who "Believes" their story would simply perpetuate a disabled state.
Steve
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Re: Work Comp/malingering - April 14, 2007 9:29:00 AM
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Rwantz
Posts: 84
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From: Middletown, PA
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No, I don't think that this is passing the buck. If we have done everything that we can for them and we question the patient's sincerity, then perhaps someone else is going to treat them as if they are not malingering.
Who are they cheating? The physician? The rehabiliation professional? Their work? The insurance?
If there are things that are not consistent they should be documented and checked. Now, if you just have a hard time believing that someone could possibly have a knee injury for a year with pain and dysfunction, but you have nothing objective and nothing concrete, then the person should be treated by someone with confidence in the patient's complaints.
I don't believe that this is enabling.
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Re: Work Comp/malingering - April 14, 2007 10:31:00 AM
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Nicole Matoushek PT MPH CSHE CEES
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I agree with many of these posts and have been exclusive in wc for about 12 years. I think the majority of injured workers are injured or perceive that they have an injury. Many of them are minor soft tissue injuries with minimal true symptomology. Other injuries are clearly affecting their function. I think there are several reasons or motivations behind reporting a WC injury. Some are legit injuries, some are psychosomatic, some are following the behaviors of others, some are looking for ways to get out of work. Our job as clinicians is to focus on the objective clinical factors that we can address and document. Recognizing when we need to communicate findings to MD, NCMs, Adjusters, referral sources etc. And recognizing when we should recommend other treatments or procedures such as RTW programs, ergo eval or FCE. Finally, recognizing opportunties for them to remain at work or return to work.
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Nicole Matoushek, PT, MPH, CSHE, CEES
http://www.ErgoRehabinc.com
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Re: Work Comp/malingering - April 16, 2007 6:41:00 AM
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Shill
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From: Madison WI USA
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Rwantz,
I have two comments on things you have said.
The first is "If you begin to doubt the patient then you will not have the belief that they are going to improve. This is not fair to the patient and it is not our responsibility to judge them." I would argue that even the patients we might think are malingering CAN get better. However, it is as much up to them as it is to us if this getting better actually occurs. Thinking that there is no one who malingers, and that we should not be thinking about this is naive. Furthermore, judging, and acting on that judgement are two different things. I try not to judge, and Im sure most of us do the same, but there are times when suspending all judgement is impossible. I have actually had a patient say to me, "I dont know how much $$ Im going to get out of this, but..." Regardless, changing treatment because of that judgement is where this becomes a problem. That becomes completely unethical.....
And speaking of unethical, when the presentation is this.."but you have nothing objective and nothing concrete", after a year, should we be treating at all? (Or, did you mean that there are no objective or concrete signs of faking it?) If the latter, then never mind the second point.
I feel as Steve does about passing pts on in most of these cases.
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Steve Hill PT
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Re: Work Comp/malingering - April 18, 2007 8:30:00 PM
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Rwantz
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From: Middletown, PA
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I meant non-objective signs of malingering. If there is nothing to show definitively that there is malingering, then the therapist/patient trust should remain that it is legit and that they can be helped. If they are not legit, can they still be helped? Of course. It would be totally unethical to ever treat someone for any period of time without some objective data showing that the service being provided is necessary. Otherwise we are just as guilty of abusing the same system.
In the case where someone states anything that denotes questionable motives, that should obviously be noted and communicated if necessary. There are also those that are sincere and don't understand the system and don't understand how they will make it back to work (or can't wait to return).
I also have found it necessary in some cases to educate the patient so that they understand the process and even helping to advocate for the patient.
I appreciate your thoughts and hope that I am more clear.
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Re: Work Comp/malingering - April 19, 2007 3:47:00 AM
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Shill
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From: Madison WI USA
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Crystal clear.
I appreciate the clarification!
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Steve Hill PT
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