TY - JOUR
T1 - The management of secondary gain and loss in medicolegal settings
T2 - Strengths and weaknesses
AU - Dersh, Jeffrey
AU - Polatin, Peter B.
AU - Leeman, Gordon
AU - Gatchel, Robert J.
N1 - Funding Information:
The writing of this paper was supported in part by grants from the National Institutes of Health (2K02 MH1107, 2R01 DE1071, 3R01 MH46452) and from the Department of Defense (PRO 23002).
PY - 2004/12
Y1 - 2004/12
N2 - Individuals with chronic illness and disability are among the most difficult patients to treat. The health-care provider is faced with an array of physical, psychological, and social factors, requiring adoption of a biopsychosocial approach to treatment. This approach necessitates consideration of the benefits for the patient of remaining ill and disabled. These benefits have been termed the "secondary gains" of illness, and they may serve to perpetuate disability and illness behavior. This paper focuses on secondary gain and loss issues in patients with chronic, nonprogressive illness associated with chronic disability, who are evaluated and treated in medicolegal settings. In working with this population of patients, the health-care provider is faced not only with the usual secondary gains of illness (e.g., escape from family responsibilities), but must also deal with the myriad of secondary gain issues unique to medicolegal settings (e.g., seeking financial compensation). Consequently, identifying and managing secondary gain issues can be quite challenging. A model for managing these issues is presented here, following a more general discussion of secondary gain and related concepts. This model has proven very useful when incorporated into an effective rehabilitation program, such as the functional restoration approach to treating chronic musculoskeletal disorders. However, shortcomings of this model for managing secondary gain have become apparent. These shortcomings, and methods for overcoming them, are discussed. The overall purpose of this paper is to improve the health-care provider's ability to identify and manage both simple and complex secondary gain issues.
AB - Individuals with chronic illness and disability are among the most difficult patients to treat. The health-care provider is faced with an array of physical, psychological, and social factors, requiring adoption of a biopsychosocial approach to treatment. This approach necessitates consideration of the benefits for the patient of remaining ill and disabled. These benefits have been termed the "secondary gains" of illness, and they may serve to perpetuate disability and illness behavior. This paper focuses on secondary gain and loss issues in patients with chronic, nonprogressive illness associated with chronic disability, who are evaluated and treated in medicolegal settings. In working with this population of patients, the health-care provider is faced not only with the usual secondary gains of illness (e.g., escape from family responsibilities), but must also deal with the myriad of secondary gain issues unique to medicolegal settings (e.g., seeking financial compensation). Consequently, identifying and managing secondary gain issues can be quite challenging. A model for managing these issues is presented here, following a more general discussion of secondary gain and related concepts. This model has proven very useful when incorporated into an effective rehabilitation program, such as the functional restoration approach to treating chronic musculoskeletal disorders. However, shortcomings of this model for managing secondary gain have become apparent. These shortcomings, and methods for overcoming them, are discussed. The overall purpose of this paper is to improve the health-care provider's ability to identify and manage both simple and complex secondary gain issues.
KW - chronic musculoskeletal disorders
KW - disability
KW - pain
KW - secondary gain
KW - secondary loss
UR - http://www.scopus.com/inward/record.url?scp=8544274451&partnerID=8YFLogxK
U2 - 10.1023/B:JOOR.0000047429.73907.fa
DO - 10.1023/B:JOOR.0000047429.73907.fa
M3 - Review article
C2 - 15638257
AN - SCOPUS:8544274451
SN - 1053-0487
VL - 14
SP - 267
EP - 279
JO - Journal of Occupational Rehabilitation
JF - Journal of Occupational Rehabilitation
IS - 4
ER -