Reasonable Suspicion Questionnaire

Dealing With Symptom Magnification

By Douglas R. Briggs, DC, Dipl. Ac. (IAMA), DAAPM

One of the greatest issues we face as clinicians is when a patient's complaints don't seem to make sense – or worse, seem to be fabricated. For a long time, if a diagnosis was not clear it was usually assumed that the patient was deliberately trying to mislead their doctor for secondary gain – either to get drugs, for personal attention, or because they "had issues." With the current trends in pain management, much has been said about the nature of a patient's pain and the standards a clinician must abide by to evaluate and care for that individual.

Pain can be defined as "an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage." As pain is experienced in the mind, and requires the mental interpretation of bodily sensations, there is a psychological overlay to every pain problem. Pain is an individual experience, and there is no way to truly know how much another person is in pain. When discussing complaints with a patient, it is best to assume that the pain exists whenever a patient says is does, and that the pain is whatever the patient says it is. Telling a person that they are not in pain basically puts you at odds with the patient and forces them to validate their complaints.

Often with an acute injury, obvious physical signs such as swelling, heat, or spasm are apparent. Orthopedic testing is very clear, and yields a straightforward diagnosis. Conditions which have become chronic (lasting longer than three months) are more difficult to quantify because there are often few gross physical signs, and orthopedic testing does not yield a clear clinical picture. Such cases are considered the grist of pain management clinics because they are so difficult to diagnose and treat. So what can we do?

Whenever a patient presents to the office with a complaint, the evaluation is critical. This evaluation starts with a good history – getting a thorough history of the patient's condition will tell you more about the patient's condition than your physical exam.

The interview cannot be too detailed. Make sure you take time to ask specifics (origin, character, exacerbating factors, etc.) Have the patient define the area of pain (dermatomal, myotomal, etc.) Your questions should guide the patient to give you relevant information, and should be posed to identify the physical, psychological, and/or emotional issues that obviously bear a great deal on the person being examined. Asking "How is your day going?" or "How has your week been?" gives insight into emotional distress that can increase their pain level. Depression always impacts on how one is feeling. A nasty boss, or a divorce, or problems with teenagers can tell another story. Once you have asked your questions give the patient time to tell you what is on their mind – too often they are rushed through an exam by their doctor – so just listening and letting them talk will give them a sense that you care and are interested in their case. With a clear history, your exam will be more focused and should better direct you examination.

Drug testing of welfare applicants | reportergary.com

Drug testing of welfare applicants

Florida and Missouri have already passed measures that require some form of drug testing during the welfare application process, with Florida now requiring all applicants to be tested. A majority of voters nationwide agree with automatically testing all welfare applicants for illegal drug use.

The latest Rasmussen Reports national telephone survey of Likely Voters shows that 53% believe all welfare applicants should be tested for illegal drug use before receiving benefits. Only 13% support randomly drug testing applicants, while 29% believe applicants should only be tested if there is a reasonable suspicion that they are using illegal drugs. (To see survey question wording,  click here .)

Governor Rick Scott of Florida signed legislation, which took effect on July 1, 2011, requiring adults applying for welfare assistance to undergo drug screening. He defended the law saying that it is “unfair for Florida taxpayers to subsidize drug addiction”.

But when it comes to those already receiving benefits, voters are more divided on the approach. A slight plurality (35%) believes recipients should only be tested when there is a reasonable suspicion of drug use. Thirty-one percent (31%) support random drug testing for welfare recipients, while 29% believe all recipients should be tested regularly.

A strong majority (70%) believes welfare recipients whoare found to be using illegal drugs should have their benefits cut off. Fifteen percent (15%) are opposed to taking away benefits in this case while another 15% are undecided.

Of those who agree with ending benefits for illegal druguse, 58% say recipients who test positive for illegal drugs should lose their benefits on the first offense. Forty percent (40%) believe there should be one or more warnings before the benefits are cut off.

When I shop for groceries, I have noted people buying food, cigarette, beer, wine, etc. While they pay for their food with their Lone Star Food Card, the rest is paid in cash. It is nothing shocking to see these folks paying with hundred-dollar bills. Often I have to wonder if these folks earn an additional income from selling drugs. They even wear better cloths then some of our local business owners wear. Ever seen their vehicles? Oy, how do they afford those vehicles?

Encyclopaedia of occupational health and safety

Human rights commissions and ombudsman offices, national experiences throughout the world

Asian Pacific American law journal

JAMA., The Journal of the American Medical Association

Evidence-based practice manual, research and outcome measures in health and human services