The Bottom Line on Using Psychological Evaluations in Treating Work-Related Injury and Illness

Based on his 24 years of experience in the field of occupational medicine, John Charbonneau, MD, MPH, FACOEM, recognizes the critical role that psychosocial factors can play in a patient’s recovery from injury or illness.

"When I talk with patients, I pay close attention to the first thing they talk about," says Charbonneau. "Do they start off by telling me their physical symptoms, or do they comment on how tough their job is, or on a problem at home? I've learned that if you don't address the first thing the patient talks about, that person won't get better."

Charbonneau believes strongly in the value of psychological evaluations in broadening the scope of treatment to promote better outcomes. "Too often, we have labeled patients as 'non-recoverers' and showing 'failure to thrive' when the truth is we just haven't gotten to the root of the problem," he says. "I wouldn't think of running my business without including a consulting psychologist."

A team of equals

Charbonneau’s practice is one of three businesses at the Ramazzini Center™ in Greeley, Colorado. Also included are Health Psychology Associates operated by Daniel Bruns, PsyD, and Back On Track, a physical therapy clinic operated by Ola Simonsson, RPT, and Kevin Younger, RPT. The three entities work closely together to provide multidisciplinary care to their patients.

"When you build a cross-functional team, it's important to work with people whose opinions you respect highly," says Charbonneau. "We come to the table as equals to share information, and together we design a patient-specific rehabilitation program. Sometimes medical issues drive our decisions. At other times, psychological factors are foremost; and in other cases physical therapy takes the lead."

Getting to the root cause calls for effective tools

In the past, identifying psychosocial factors that may be influencing a patient's recovery has been difficult, Charbonneau acknowledges. "For some years, we didn't have really effective assessment tools," he says. "Too often, psychological evaluations looked at the patient as if life began at the time of injury or illness. They failed to look at personality development and pre-injury/illness psychological functioning. And so, de facto, psychological diagnoses were attributed to the injury."

Charbonneau comments on how the BHI™ (Battery for Health Improvement)¹ assessment has helped address this gap. "The BHI instrument helps us gain a comprehensive picture of the patient—both pre- and post-injury/illness," he says. "And most important, it is the only psychological test that is normed on physical rehabilitation patients as well as a large community sample. It uses the average physical rehabilitation patient as a benchmark for interpretations and recommendations. For the first time, we have an instrument that allows us to compare apples to apples."

The BHI assessment helps Charbonneau and his colleagues quantify the right balance between physical and psychological treatment in developing individually tailored rehabilitation plans. "No other assessment has allowed us to do that," says Charbonneau.

Reducing long-term costs

But doesn't performing psychological evaluations for medical patients in the workers compensation system drive up employer costs?

Quite the contrary, Charbonneau says, citing notable statistics:

• Research conducted with Bank One employees found that mental health disorders were the number one cause of absence from work and the number three cause of lower workplace productivity (Burton, Conti, Chen, Schultz & Edington, 1999).
  
  
• In a World Health Organization study of more than 26,000 subjects in 14 countries, it was found that physical disability was more closely associated with psychological factors than with medical diagnosis (Ormel, VonKorff, Utsun, Pini, Korten, & Oldehinkel, 1994).
  
  
• In a study of Boeing employees, it was found that psychosocial factors (job dissatisfaction, hysteria and antisocial traits) were better predictors of who would file a workers’ compensation claim than were 53 medical variables (Battie & Bigos, 1999).

"Clearly, the use of psychological evaluations presents an opportunity to help employers save costs in the long run from such factors as chronic absenteeism and lower productivity," says Charbonneau.

"Do you realize what it costs companies every day for employees to have untreated psychological conditions?"

A changing trend

Charbonneau notes that while convincing companies of the benefit of psychological evaluations has at times been "a wrestling match," the trend is shifting. He points out that more and more state workers' compensation guidelines are recommending psychological intervention sooner rather than later.

At the Ramazzini Center, Charbonneau and his colleagues are dedicated to promoting this trend. "We are taking the message to corporate America—showing them the evidence and asking them, "Do you realize what it costs companies every day for employees to have untreated psychological conditions?"

"We see a great opportunity to improve diagnosis and care for workers," says Charbonneau, "and to benefit their companies and the broader community by helping these patients become more productive citizens."

Dr. John Charbonneau is the founder and president of Occu-Care, Inc.™, a full-time private practice occupational medicine clinic at the Ramazzini Center in Greeley, Colorado. In addition to private practice, Dr. Charbonneau serves as a regional consultant for Union Pacific Railroad, Hewlett Packard Company and Agilent Technologies, on-site physician consultant at Kodak-Colorado division, and regional medical director for State Farm Insurance. Previously, he served as medical director at Benchmark Worker Rehabilitation Services.

¹ The BHI (Battery for Health Improvement) was developed by Daniel Bruns, PsyD, John Mark Disorbio, EdD, and Julia Copeland, PT.

Works cited

Battie, M.C. & Bigos, S.J. (1991). Industrial Back Pain Complaints: A Broader Perspective. Orthopedic Clinics of North America 22(2).

Burton, W., Conti, D., Chen, C., Schultz, A., & Edington, D. (1999). The Role of Health Risk Factors and Disease on Worker Productivity. Journal of Occupational and Environmental Medicine 41(10).

Ormel, J., VonKorff, M., Ustun, T. B., Pini, S., Korten, A., & Oldehinkel, T. (1994). Common Mental Disorders and Disability Across Cultures. Journal of the American Medical Association, 272(22), 1741–1748.

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