13 June 2012

A legal action

A patient came in because he was litigating a worker's compensation complaint and hoped his physician would support his case. Everything bad that had happened in his life over the past few years he attributed to an injury to a limb that he claimed he had suffered on the job.

The examination was quite uncomfortable for me, because the patient actively tried to sell me on just how injured he was. Things became adversarial at times: he asked me if I doubted that the injury was the only explanation for his medical problems. When I touched the affected extremity, the patient cowered in pain and admonished me. The affected extremity did look abnormal. Then again, he had stopped using it since the injury. When a part of the body isn't used, it atrophies, distorting the anatomical structures and its appearance.

Was he exaggerating his pain to sell me on his legal battle? Was his pain in part psychological, brought on by the perceived injustice of having suffered an injury on the job? To what extent was the original injury responsible for the pain, and to what extent was it due to atrophy after the patient decided to stop using it? Was this a rare pain disorder? Was this all an invention by the patient, in a nefarious bid to collect disability and retire early?

This was not the fun kind of medicine, especially because I was more referee than healer. Some physicians specialize in workers' compensation cases, and serving as an expert witness in legal cases pays quite well. It's not what I came into medicine for, though, and this case made me quickly decide that this type of medical practice is not for me.