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Robert Aurbach

Abstract

When injured persons feel pain and a physician tells them that they have a permanent condition, the feeling of pain can become associated over time with the diagnosis, the emotional response to the diagnosis, and factors associated with the diagnosis (including helplessness, fear, anger and overwhelming stress). Even the language associated with the process can be misleading: To some, the phrase “maximum medical improvement” may have the ominous ring of a life sentence with a judgment that they have reached the highest potential for recovery, even if this is not the case. The US legal system often contributes to needless disabling, to the extent that the author coins the term “attorneyogenic disability.” Delaying dispute resolution following disputes in the case causes harm by creating a period when injured workers may obsess about their condition, the people who have wronged them, and the unfairness of the system in failing to compensate them. As delays stretch on, the individual's perception of physical symptoms may become habitual in a complex association of thoughts, feelings, and emotions that affect the worker's neural network. Finally, the legal system stops when the claim is resolved, and the patient's advocate has no systemic motivation to assist after the claim is completed. Planning for functional adaptation and treatment after the dispute resolution often is lacking, especially after the individual has been exposed both to catastrophic thinking in the courtroom and multiple medical evaluations and treatment protocols.

in AMA Guides® Newsletter
Robert Aurbach

Abstract

Resilience has been a disappointment in the context of understanding why some people bounce back from injury, illness, or other challenges, but others do not. Researchers have identified characteristics that are found in people they deem to be resilient, but these characteristics are too general to be used effectively and do not demonstrate how to build or reinforce resilience. Humans form habits of thought, feelings associated with particular stimuli, and behaviors in response to stimuli, a process known as neuroplasticity. Injured or ill individuals often are presented with additional stimuli that maintain the associations and expand the scope of illness. In the privacy of their own minds, individuals may repeat self-negating thoughts about economic pressure, loss of work identity, psychosocial issues, and others that lead to anger, frustration, worry, catastrophic thinking, and grief—creating a web of disability. In this context, resilience can be reframed as the ability of a person to change, quiet, or moderate self-talk in order to minimize their long-term reaction to stressors. To foster resilience, individual interventions can be undertaken as general life training, specific inoculation against anticipated situations, or in a remedial role to help those whose experience of challenges has been exacerbated by an inner voice that is out of control. Workplaces that enhance rather than diminish individual resilience allow productivity and wellness to coexist and reinforce one another.

in AMA Guides® Newsletter