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Usual Care Treatment Process: Strengthsand Weakness Within Occupational Medicine

Discussion of Usual Care Treatment Process: Strengthsand Weakness Within Occupational Medicine

Many physicians manage musculoskeletal disorders within the biomedical model, asthis was how they were trained. Most orthopedic and neurosurgeons, who providethemajority of specialist care for workers’ compensation injuries, did not have a psychiatricrotation during residency training, and psychologists and psychiatrists are notpart of the traditional teaching faculty in these residency programs. Most orthopedicand neurosurgeons have strong obsessive compulsive personality traits, which makesthem perfectionists who are very detail oriented (critical for surgeons), good withdifferential diagnosis, and hardworking/goal oriented. However, this personality styleis uncomfortable with emotions – their own, their significant others, and theirpatients’ emotions (Oldham & Morris, 1990). Thus, the same personality traits that make many orthopedic and neurosurgeons good surgeons give them “blinders” to thepsychological makeup of their workers’ compensation patients. While this “unemotional”personality hinders their perception of psychosocial issues, it allows them to remaincalm while treating critical medical illness and in surgery.

Occupational Medicine physicians vary. Some have been residency trained inoccupational medicine, and some of these may have had exposure to psychologistsand psychiatrists during residency training. The majority of private practice occupationalmedicine physicians were residency trained in some other field, and evolvedinto an occupational medicine practice over time after their formal medical educationwas complete. Most occupational medicine physicians, however, have done multiple“fitness for duty” exams for employers in which the issues were psychiatric orpsychosocial,so as a group they may be more perceptive in recognizing and morecomfortable dealing with the psychosocial issues of workers’ compensation patients.In addition, occupational medicine physicians may allot more time per patientvisit compared to surgeons, since their hourly practice overhead is less. There isevidence that spending additional time with back pain patients can significantlyimprove outcomes (Indahl, Velund, & Reikeraas, 1995).

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