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 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.