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If you ask a patient who is out of work because of an illness or injury what caused his condition, he may just blame it on his boss or co-workers.
This is a clue that work-related stress and the psychological issues it can cause may affect this patient’s return to work, according to Mark Raderstorf, MA, CRC, CCM, a licensed psychologist and president of Behavioral Management Inc., a Minneapolis, MN-based company that provides case management for employers and insurers in cases in which there is a psychological component.
"If you have a physical condition that impairs someone and it’s not improving, more times than not, it’s highly likely that [the patient] has psychiatric issues preventing their recovery or holding them from functioning," Raderstorf says.
Work stressors can contribute to longer medical leave, Raderstorf says.
"The patient may not be getting along with the boss or some of the co-workers. These stressors add anxiety to that individual’s mental health status. They can become obsessional or very depressed about their job situation," he says.
If this issue occurs with one of your patients, it may be advisable to step in and try to mediate the problems in the work place in an effort to get patients back to work, Raderstorf says.
"One area that may be neglected is mediating those work place stressors. A case manager is in an ideal position to step in and rebuild those relationships, " Raderstorf says.
For instance, you may have an employee who has been on the job for many years and is very dedicated to the company. He doesn’t want to leave but has the perception that the boss is unreasonable or unsympathetic. The stress can be manifested in physical symptoms — chest pains, gastrointestinal problems, or headaches. Or the employee may be anxious or depressed. "He could have a physical or a psychiatric scenario or a combination of both that is clearly contributing to his overall recovery," Raderstorf says.
Or, you may be seeing a patient with a back injury who is working hard on physical therapy. However, knowing that she eventually will go back to work and have to deal with her boss may cause the patient to become anxious and tense, which can lead to psychosomatic pain.
Watch for clues as to workplace stressors that may impede recovery and take steps to solve them as soon as possible, Raderstorf advises.
"Our studies have shown that the earlier we intervene, the better the results," he adds.
Whether you get to know the patients face-to-face or by telephone, ask what their understanding is of what led them to take medical leave. Sometimes patients will say right out that they feel the boss caused the condition. Other times, it may be a subtle comment here or there: "My boss wasn’t that supportive," or "My co-workers make discouraging remarks."
You’ve got to pick up on it and follow through, Raderstorf says. For instance you could ask what a patient’s plans are and what he or she hopes to see happen.
Patients may say they want to go back to the company but don’t know if they want to go back to their old department. In some cases, a client already may have decided against returning to his or her former place of work.
But, if they may go back, it’s important to try to shore up the relationships at work, Raderstorf says. "Sometimes they need a neutral outside party who is objective to facilitate the communication," he says.
"Some case managers may shy away from getting involved in mediating work place relationships, but they’re doing a disservice to the client, the patient, and to the people who are paying for the care," Raderstorf says.
The first place to intervene is with the human resources person, the return-to-work coordinator, or the risk manager.
"We strongly recommend that case managers have some kind of interaction with the supervisor. Stress to the human relations person that you’d like to talk to the supervisor and get their take on the situation," he adds.
Raderstorf often sets up a return-to-work planning meeting to help ease the injured worker’s transition back to work.
He contacts the supervisor and the human resources director and tries to bring the two parties together so they can talk out the issues.
Sometimes, he meets privately with the boss and the human resources director beforehand to get an understanding of what may be going on at the company.
Raderstorf has found in his experience that some employers are very open and cooperative and are willing to look at reasonable accommodations and a flexible work environment.
Some are very open to trying to shore up the relationship between the employee and co-worker or supervisor. "In other situations, the bad blood is so thick that no amount of mediation or return to work planning is going to overcome it," he adds.
When that happens, the employer needs to know that his decision not to take the patient back probably will prolong the claim and mean higher costs over time, he says.
Raderstorf encourages case managers to avoid what he calls "a bossectomy," a situation in which the client wants to remove the boss from his or her work environment.
Some clients want to go back to the company but don’t want to report to their old boss. In that case, situation, the case manager should mediate the relationship between the employee and the boss and do what can be done to shore up the relationship and move in a positive direction, Raderstorf says.