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In it’s simplest form it’s what it sounds like: someone who attends to, or pays attention to, you. When you’ve got the flu it’s good to have someone who will check on you, get you some medicine, and bring you something to drink when you want it. That’s what loved ones do. Now say you had a total knee replacement and cannot walk or stand for any meaningful length of time. And throw into the set of facts that you are single and live alone. You need someone to take care of you. There is no way your are going to heal if you are having to abuse yourself taking care of your every day activities. The adjuster needs to pay for attendant care. It’s part of getting you better just like therapy, medications, and surgery.

Let’s take this scenario a step further. Everything is the same except that you are married. What’s the adjuster going to do? In at least 99% of the thousands of cases we’ve handled the adjuster expects your spouse to take care of you. If that means he or she takes time off of work without pay or uses up vacation or Family Medical Leave Act time the adjuster doesn’t really mind. We think this is wrong. Just because you have family who loves you doesn’t mean the insurance company shouldn’t pay for your medical care.

Largely through the efforts of one insurance company – after losing a case in the Court of Appeals about attendant care – the 2011 laws placed strict regulations on attendant care. We’ve become adept at making sure our clients are in compliance with these new (and in our opinion unnecessary) rules. The key thing is that your doctor needs to document the need specifically, for a limited period of time, in advance of the surgery. If things are done correctly your loved one will be compensated for the services he or she provides. Keep in mind, though, that the compensation rate is what a home health aide would get paid – usually about $10.00 – even if that’s less than what your spouse makes on their job. Every little bit helps though.

Wikipedia gives as good a definition as any: Pain management is a branch of medicine employing an interdisciplinary approach for easing the suffering and improving the quality of live of those living with pain. That’s well and good but what does it mean in the context of workers’ compensation?

We usually see pain management coming when a surgeon is done with you but you still have problems functioning and with pain. The surgeon may see his role as ending after the operation. It is up to a different specialty to handle the long-term results and recovery from this. While that could seem like the surgeon is just handing you off to someone else it’s not that simple and it’s not that callous.

In a deposition we took a prominent pain management doctor testifies that 80% of patients with chronic pain (that is defined as pain which last for six months or more) will develop clinical depression. Our bodies are not designed to put up with pain for that long. As much as we all want to see people get 100% better sometimes that doesn’t happen. People learn to live with pain. They do this sometimes with medications, sometimes with therapy and exercise, sometimes with counseling, and often with a combination of all that. Truthfully, managing all this is a skill set completely different than performing surgery.

Clients shouldn’t feel neglected or abandoned when their surgeons refer them to pain management. What we do see happen, though, is that pain management specialists can seem to exhibit a certain sense of prejudice. A lot of injured workers have reported that their pain doctors view them skeptically. It’s almost as if it’s ok to be in pain management if you have cancer but if you are there after a failed back surgery you should buck up and stop your whining and nothing cures like some tough love or a kick in the butt. If true such an approach is reprehensible in our minds.

Our best advice to clients in this predicament is to avoid playing into stereotypes and prejudices. As we’ve said repeatedly it is important to retain your credibility with your doctor. That means you’re complaints and self-assessments should be accurate, clear, and not exaggerated. It’s important to note that we’ve seen plenty of medical records with references to “non-organic pain” or “non-physiological pain” and “symptom magnification.” Many of these doctors are clued in for evidence that you are not being accurate or honest. When it comes to an issue like pain, which cannot be measured with a thermometer or an MRI, you word has to be 100% solid.

A Functional Capacities Evaluation, or FCE, is theoretically a test that fairly and accurately evaluates a person’s capacity to work at certain levels over a lengthy period of time. There are a number of different FCE systems in place but they share certain things in common.

First, a therapist will likely explain what is expected and tell you that you do not need to perform any tasks that you feel you cannot safely do. She or he will interview you to confirm what your injury is.

Second, the therapist will likely perform a series of physical tests moving you around and asking you to do things while distracting you by speaking to you or having you answer questions. The purpose of this is to see if you unconsciously move without pain when you have already told them it hurts to move.

Third, the therapist will perform an extensive number of validity tests. Some, such as a test that tests your ability to squeeze a handgrip, are designed to see if you are giving full effort, have a significant support among medical literature. Others, such as a series of tests given to people complaining of back pain, have been repudiated by the designer of the test.

Fourth, the therapist will prepare a report which will be given either to your doctor or to your rehabilitation nurse. While we have seen an instance of a rehabilitation nurse falsifying the FCE results before giving them to the doctor we believe this to be a rare occurrence.

An FCE can be very beneficial to an injured worker to the extent that it demonstrates to a doctor what you can and cannot do. The downside of the FCE, in our experience, is that the therapist has a tremendous amount of flexibility in deciding if you’ve given full effort. Nothing, we repeat, nothing will destroy your relationship with a doctor like a FCE report which says you gave less than full effort.

What causes us a lot of concern is that some physical therapy groups aggressively market their FCEs to insurance adjusters as a way to bring claims to a close. That, to us, seems like a thinly veiled promise to either recommend little to no restrictions or to declare someone to be giving submaximal effort. We reviewed a report from one such group that stated in the opening and closing paragraphs that the patient had failed some validity tests and had given submaximal effort. When we combed through the full report (which, by the way, was not given to either the doctor or us… we had to subpoena it) we discovered that the client had passed 27 of 30 validity tests. So yes, it was true that he had failed three. And yes in English “three” is “some” but we believed this to be a clear effort to paint a negative picture about a very honest injured worker. Another example we’ve seen repeatedly is a therapist asking a patient about his pain level before and then after the test was done. According to this particular FCE protocol if your pain is 5/10 when you start the FCE your pain should be no more than a 7/10 when you finish. If you say it’s an 8/10 then you get dinged for symptom magnification. Why? Because the FCE protocol says your pain should only go up by two points. Huh?

A substantial amount of literature supports the theory that an FCE should be performed twice. It’s well documented that a person’s performance may appear submaximal strictly due to the unfamiliarity of the situation. We’ve personally had many clients whose second performance has no trace of submaximal effort reported – even though the overall demonstration of strength did not change one bit.

Finally, many believe that indisputable evidence such as temperature, blood pressure, and heart rate are more reliable indicators of effort than the subjective impression of therapists who market their testing to workers’ compensation adjusters.

Symptom Magnification refers to the reporting of symptoms that are greater than what would be expected. But that is a very unsatisfying definition. In the context of a workers’ compensation claim, it’s just about the worst thing one can say shortly after calling someone an outright fraud. The problem with labeling someone with such a drastic term is that in medical literature, it is clear that the tendency to overstate symptoms may be unconscious or conscious. Yet, in everyday usage, it has come to mean intentional lying.

Symptom Magnification Is a Psychological Condition That Affects People With Chronic Illness

Symptom magnifying is a psychological condition that affects people who suffer from chronic illness. Symptoms are exaggerated because they’re out of proportion to the actual problem. This causes stress and anxiety, which leads to depression.

Symptom magnification is a real issue for many people with chronic illnesses. Many doctors and therapists recommend cognitive behavioral therapy (CBT) to help patients cope with these issues. CBT teaches people coping skills and allows them to recognize negative thoughts and beliefs that cause them to experience symptoms.

Symptom Magnifiers Tend to Focus On Their Symptoms

The most common symptoms include fatigue, pain, nausea, diarrhea, vomiting, shortness of breath, loss of appetite, weight gain, insomnia, muscle cramps, and headaches. These symptoms are not necessarily bad things; however, when they occur frequently and last long periods, they can be signs of severe health problems.

If you’ve ever had a bout of flu or experienced stomach pains after overeating at a restaurant, you’ve already witnessed symptom magnification. So next time you notice yourself feeling sick, remember that it’s just your body telling you something isn’t right.

What is symptom magnification?

Symptom Magnifying Can Lead To Depression

Symptom magnifiers often feel helpless and hopeless, making them prone to self-medicating with alcohol, drugs, food, sex, gambling, shopping, etc. They may also become isolated from friends and family.

When you have a chronic illness, you need to learn how to manage your symptoms, so you don’t get overwhelmed by them. You should also know what triggers your symptoms and avoid those situations. If you do this, you’ll find that your symptoms will decrease and eventually disappear.

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A case comes to mind involving a woman with a shoulder injury. She was seen by an Occupational Medicine doctor, who we have come to view as being rather callous and indifferent to workers’ compensation claimants. When our client did not respond to treatment, this doctor labeled her as symptom magnifying and discharged her as a patient. Subsequently, an MRI revealed a torn rotator cuff.

So, while the patient’s complaints were more remarkable than what the doctor expected, the error lay with the doctor’s indifference and decision not to order an MRI, which would have supported the patient. This is not at all an isolated instance. We reviewed medical records where an orthopedic surgeon vilified an injured worker after back surgery. The worker was complaining of symptoms more significant than what the doctor expected. That was undoubted because a neurosurgeon evaluated what the orthopedist had done and discovered that the first surgeon had operated on the wrong level in the back.

What’s our point in telling horror stories? It’s what we’ve observed, “the other side” doing about injured workers. Just because a couple of people, among the tens of thousands of injured workers, exaggerated their symptoms doesn’t mean every workers’ compensation claimant is lying about their condition. Yet some healthcare professionals who work closely with the insurance adjusters seem to take a “guilty until proven innocent” view. It’s not fair if they pre-judge you before they even do a physical examination.

What can you do about this? We’ve said it before, and we’ll repeat it: avoid dramatic overstatements of pain. They never do you any good and can often cause many unintended problems.

Secondary Gain: What Does It Mean?

Secondary gain is a psychological term that refers to a motivating factor that a patient has in reporting symptoms or complaints of pain. More simply, the secondary gain is an outside reason or benefit to complaining of pain or mental or physical symptoms. For instance, if you tell your doctor, “I think I broke my arm because the bone is sticking out of my skin,” you obtain medical treatment. You also have a secondary gain in that you may get paid time off of work or even a little extra attention from your family.

For example, many people work hard to achieve financial security because they believe this will give them the freedom to spend time with family and friends. However, they often sacrifice relationships with loved ones to repay debt and save money. This is called secondary gain.

Another example involves people who smoke cigarettes despite knowing that smoking causes cancer. They feel guilty about harming themselves, so they continue to smoke to avoid feeling bad about themselves. This is another form of secondary gain.

To understand secondary gain, you need to understand human motivation. Human beings are motivated by three basic needs: safety, belongingness, and self-esteem. Security means avoiding harm and injury; belongingness means being accepted and appreciated; self-esteem means having positive feelings toward oneself.

In its proper use, the phrase secondary gain does not imply that the patient even recognizes or realizes the gain being given to them. Specifically, secondary gain does not require or include any type of conscious thinking on the part of the patient.

What is secondary gain?

What is the Difference with Primary Gain?

The difference between primary and secondary gain is that the former is consciously recognized as such while the latter is not. In other words, primary gain is when someone consciously thinks about what he or she wants or expects to receive for reporting certain symptoms or complaints. The secondary gain is when someone reports these symptoms or complaints without realizing that there is a secondary gain involved.

This distinction can be illustrated through the following examples:

Example 1: A person comes into the office with a broken leg. He says, “My leg hurts really badly. Can you please help me?”

Primary gain: The person is seeking medical care because his leg is hurting.

Secondary gain: The person is trying to avoid getting fired from his job.

Example 2: A person comes into our office with a sore throat . She says, “I am going to go home sick today. My throat hurts too much to talk.”

Primary gain : The person is seeking medical treatment because her throat hurts.

Secondary gain : The person is afraid of losing her job.

How do we know if a patient is experiencing secondary gain?

There are several ways to determine whether a patient is experiencing secondary gains. One way is to ask him directly. Another way is to observe how the patient behaves during the visit. If the patient appears anxious, nervous, or depressed, then he probably experiences some sort of secondary gain.

If a patient seems to be enjoying himself, then he most likely does not experience secondary gain.

When Secondary Gain Happens…

If you’re feeling stressed, you may be experiencing secondary gain. Perhaps you’ve been working too hard and haven’t taken care of yourself. Maybe you’re worried about making ends meet. Whatever the reason, you may be acting selfishly instead of helping others.

To avoid secondary gain, you must become conscious of your motives. Ask yourself whether you’re being helpful. Is your motivation genuine? Are you just trying to justify your actions?

There are many ways to identify secondary gain. A straightforward method is to ask yourself, “Is this behavior serving me well?” Another way to identify secondary gain is to ask yourself, “‘Do I deserve to be happy?'”

Another way to detect secondary gain is to notice the difference between your feelings when you’re alone versus when you’re with others. Do you feel better when you’re with friends and family? Does your mood improve when you spend quality time with loved ones?

How to Deal With Secondary Gain

People often use secondary gain to get what they want. For example, when trying to sell a product, you may offer free shipping because it makes you seem more trustworthy. Or, when trying out a restaurant, you may pay extra for a table near the window because you want to feel special.

The problem is that sometimes we use secondary gain to avoid dealing with uncomfortable emotions. We try to convince ourselves that our feelings aren’t real or that we deserve them. But this only leads us down a path of self-destruction.

When you’re feeling sad, angry, jealous, or afraid, you should ask yourself whether your feelings are justified. Is there some reason you shouldn’t feel that way? If not, then you need to let go of your emotional pain. Otherwise, you’ll just keep going through life, avoiding unpleasant feelings. And that won’t lead to happiness.

Why People Do Things, They Don’t Want To Do

Unfortunately, in workers’ compensation circles, the term secondary gain is often interchanged with the term malingering. Malingering involves intentionally lying about a condition to obtain benefits. In a workers’ compensation claim, malingering can and should be avoided, but the secondary gain cannot be. That’s why we are offended when rehabilitation nurses and some doctors roll their eyes using the term secondary gain. Many of them act like you receiving surgery to repair an injury you suffered due to your employer’s negligence is a sign that you’re a terrible person. We think that is unfair.

Secondary gain is different from malingering. The latter involves intentional deception. It is wrong. Secondary gain is simply a psychological phenomenon. It does not involve any sort of dishonesty.

In fact, secondary gain can even be a good thing. It helps people cope with difficult situations. When someone is suffering, he or she will do anything to make himself or herself feel better. 

Why is Secondary Gain Important?

Secondary gain is important because it may cause patients to report their symptoms in an exaggerated manner. Patients who have experienced secondary gain tend to exaggerate their symptoms. This exaggeration makes it difficult for doctors to diagnose and treat illnesses.

For instance, if a patient has a headache, but claims that it is 10 times worse than usual, this could indicate that the patient is experiencing secondary gain. It would be very difficult for the doctor to accurately assess the severity of the pain if the patient were experiencing secondary gain.

Another reason why secondary gain is important is that it can lead to unnecessary tests and treatments. For example, if a patient complains of chest pains, then the doctor might order an EKG test. However, if the patient is only exaggerating his symptoms, then the doctor will not learn anything new by ordering the test.

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