Abstract

Disability is a prototypically biopsychosocial phenomenon, and the majority of workplace absences resolve easily and with an expedited return to work. In a minority of worker absences, recovery is delayed less by clinical factors and more by psychosocial variables that can take up an inordinate amount of time from the health care provider (HCP) and also may drive up total costs. Multiple stakeholders participate in this process—the HCP, the patient, the employer, and the insurer—each of whom has overlapping but distinct perspectives and agendas. Often HCPs find themselves in the middle of a complex set of interactions in which competing agendas may be played out. By engaging in effective communications with key stakeholders, the HCP can play a key role in ensuring that the most appropriate clinical outcomes occur. Despite the complexity of the underlying variables, the principles of effective communication are relatively straightforward: Apply a biopsychosocial model rather than a purely biomedical one; bear in mind that key psychosocial variables involved in delayed recovery include variables on the part of the individual, the employer, and the HCP; recognize that psychosocial factors that contribute to delayed return to work are not impairments that require medial or psychological treatment; listen; reach out to employers; and develop nonadversarial relationships with claims adjusters whenever possible.

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