The Emperor Needs More Clothes: Conventional training has not prepared us to help a critical subset of worker-patients

When Jennifer Christian and four ACOEM colleagues began developing a continuing education course for physicians entitled “Getting Difficult Cases Unstuck”, they realized that some specific interpersonal and analytical skills are required to turn difficult cases in a better direction – yet are not usually part of medical training. Difficult cases commonly involve patients/employees who:
a) have medically-unexplained symptoms;
b) have problematic attitudes, beliefs and behaviors, or vulnerabilities due to traumatic past histories;
c) fail to improve as expected with recoveries that have stalled out; and
d) have ended up with an unexpectedly poor outcome, most often a combination of chronic pain, distress, functional impairment, and prolonged work disability.

By attending this session, you will learn about this subset of patients and the skills clinicians and non-clinicians must have in order to successfully conduct the critical conversations that can turn around a difficult situation and steer the course of recovery in a better direction.

Learning Objectives:
1. Describe the subset of patients/employees that doctors are unprepared to help due to the bio-medical focus of our training programs and repertoire of treatment options.
2. Name several key skills and interventions that are required in order to help this vulnerable subset achieve better outcomes.
3. Describe at least one way in which the usual “assembly line of care” must be modified to meet the needs of this subset.
4. Describe the concept and purpose of an engineered therapeutic interaction.
5. Explain why and how broadening our view, mastering some key skills, and expanding our repertoire can make us more effective, improve our patients’/employees’ lives, and increase our professional satisfaction.