A 40-year-old jobless man with persistent back pain arrives at the office for a consultation with a new doctor. Years ago, the patient damaged his back in a job accident and has not worked since. He acknowledges that he takes marijuana everyday to "calm the agony" and that a percentage of his earnings go toward its purchase. The patient claims that nothing has changed and requests that the doctor sign a disability form so that he can continue to receive disability benefits. When the doctor inquires about his condition and previous treatment, he responds furiously, "I wouldn't be here re-applying for disability if anything had worked," slamming the disability form down on the table. The patient walks normally with no apparent discomfort or limitations. Which of the following is the most appropriate response by the physician?

Question

A 40-year-old jobless man with persistent back pain arrives at the office for a consultation with a new doctor. Years ago, the patient damaged his back in a job accident and has not worked since. He acknowledges that he takes marijuana everyday to "calm the agony" and that a percentage of his earnings go toward its purchase. The patient claims that nothing has changed and requests that the doctor sign a disability form so that he can continue to receive disability benefits. When the doctor inquires about his condition and previous treatment, he responds furiously, "I wouldn't be here re-applying for disability if anything had worked," slamming the disability form down on the table. The patient walks normally with no apparent discomfort or limitations.  Which of the following is the most appropriate response by the physician?

Quizplus · Accepted Answer

Eductional Objective: In the United States, disability insurance is provided by commercial insurance companies or the Social Security Administration. It offers financial help to employees who are unable to work due to a medical or psychological problem. These entities normally demand a physician's certification of impairment before granting the award.
The patient's request that the doctor sign a disability paper creates a tricky scenario. Pain is very subjective, and the physician knows very little about this patient at this point in the encounter. Malingering or exaggerating the level of impairment to receive benefits, improperly managed pain, or persistent pain resulting in real disability are all possibilities. This patient may also have had negative interactions with health care providers or a psychiatric condition that contributes to his angry, demanding behavior. The best approach is to politely but firmly explain that determining medical disability requires further assessment of his symptoms, physical examination, and testing if indicated.

A 40-Year-Old Jobless Man with Persistent Back Pain Arrives at the Office