Enelow A J
Calif Med. 1967 Mar;106(3):179-82.
The complexities and interferences in the doctor-patient relationship during the treatment of the compensably-injured workman create an unusually high incidence of delayed recovery, complications, and permanent disability. Many persons, once injured, never return to economic self-sufficiency. Among the factors that may have a bearing in producing this situation are: The psychological context of the injury itself; the personality of the patient; the "reverse incentive" created by reward for illness; third-party interference from attorneys, insurance claims adjusters, and union representatives; consequent hostility of the patient toward a doctor he usually has not chosen; and, too often, hostility of the physician toward his patient. Iatrogenic complications may also be present when ill-advised surgical procedures are used in the presence of psychological complications. To improve the situation the adversary system should be removed and outside interferences in treatment should be reduced. Physicians treating patients in such circumstances should learn more about psychiatric diagnosis and management. They should give more attention to remotivation and rehabilitation.
在对因工受伤工人进行治疗的过程中，医患关系的复杂性和干扰因素导致延迟康复、并发症和永久性残疾的发生率异常高。许多人一旦受伤，就再也无法实现经济上的自给自足。可能导致这种情况的因素包括：受伤本身的心理背景；患者的个性；疾病奖励所产生的“反向激励”；律师、保险理赔员和工会代表的第三方干扰；患者因此对他通常未选择的医生产生的敌意；而且，医生对其患者的敌意也屡见不鲜。当在存在心理并发症的情况下采用不当的外科手术时，也可能会出现医源性并发症。为改善这种情况，应摒弃对抗性制度，并减少对治疗的外部干扰。在这种情况下治疗患者的医生应该更多地了解精神科诊断和管理。他们应该更加关注重新激发动力和康复。
