I have such mixed feelings when I get a denial from workers comp... Say a patient comes in with radicular symptoms and MRI findings that can be related to the pain. On physical exam, they have no objective findings of radic, with 5/5 strength, normal sensation and reflexes (I believe workers comp doesn't care as much about SLR test). If I document it this way, and request ESI, then it will get denied. Workers comp does not understand that you can have painful radiculopathy without objective neurological findings. If the patient was malingering anyway, then that is fine, but how does one ever know for sure? If the patient was really in pain, then they are getting denied treatment that could help their pain. If convince myself that maybe that muscle was 4+/5 and not 5/5 and document it that way, then it meets their criteria and gets approved... We can also have a similar discussion about splitting hairs between documenting 50% relief with a procedure versus 70 or 80% relief... What is one to do? Perhaps as PMR4MSK posted above, I should use the line, "I have nothing to offer this patient". My problem is I just don't see the world as black and white, and hence I am always feeling like I am caught in the middle.
Sorry to drag this out, but along that lines, when a patient says they can't go back to work, and you don't see any objective reason why they couldn't...how does one move forward? I don't see how it is helpful to tell that patient they can go to work when they firmly believe/claim that they can't. It is similar to a patient coming in with what seems like non-organic pain, and you don't see why they should have pain...it is not helpful to tell them that they don't have pain because it is a subjective experience.
I guess I am not really asking any specific questions, but just soliciting thoughts and comments from others, as I think it would help me to shape my own mental framework as far as how to work with these patients.