Social labeling, stereotyping, and observer bias in workers' compensation: The impact of provider-patient interaction on outcome

Abstract

When injured workers with chronic musculoskeletal disorders are viewed through the narrow lens of the biomedical model, the role of situational factors is not acknowledged, and their illness behaviors and delayed recovery are often attributed to personal weakness or a desire for secondary gain. This leads to a tendency toward blame and the application of stigmatizing social labels. An overt or implied social label that carries a stigma can set into motion therapeutically counterproductive biases in social perception within the provider-patient relationship. One of most powerful of these has been called the self-fulfilling prophecy, in which expectancy-driven behaviors of the clinician, case manager, or insurance representative can subtly direct the patient to behave in a manner consistent with expectations. Justification for an attitudinal shift among providers of workers' compensation services is proposed, along with application of the biopsychosocial framework of health psychology to the problem of delayed recovery in injured workers.

Occupational back pain -- an unhelpful polemic

“…Newly identified feedback loops involving tissue inflammation, nociceptive sensory nerve stimulation, and central nervous system or endocrine amplification (58-62) have been identified in fibro~nyalgia patients. Chronic back-pain patients may be experiencing a similar, poorly understood vicious cycle of pain perpetuation, sometimes exacerbated by medical and social labeling of their problem as "psychogenic" (49,(63)(64)(65)(66)(67). Considering the complex natural history of chronic pain development in back-pain patients receiving compensation payments, the use of the simplistic and victim-blaming term "compensation neurosis" would now appear to be unjustified (66).…”

Physical therapists' perception of patients' pain and its affect on management

“…This leaves the therapist with feelings of diminished professional competence and frustration. As found by Niemeyer (1991), when working with injured workers with chronic musculoskeletal disorders, situational factors are not acknowledged by therapists. Rather, illness behaviors and delayed recovery are often attributed to personal weakness or desire for secondary gain.…”

“…Leavitt and Sweet determined guidelines for clinical judgment concerning malingering in patients with low back disorders (Niemeyer, 1991). Clinical signs considered to be important indicators for malingering by 70-80% of the 105 orthopedic and neurosurgeons surveyed included:…”

Perceptions of a Quality of Work-Life Survey from the Perspective of Employees in a Canadian Cancer Centre

“…Labelling Theory, originally developed from studies on deviance, has been applied to mental disorders, drug abuse, infertility, homosexuality, and physical disability (Mason et al, 2001). In the occupational literature, this theory has been applied to repetition strain injury (Reid et al, 1991) and injured workers in general (who are labelled as "malingerers" or people taking advantage of workers' compensation systems) (Niemeyer, 1991). To date, Labelling Theory does not appear to have been applied to psychosocial constructs associated with quality of work-life, or other, surveys.…”