Results of medical treatment are notoriously poor in patients with pending litigation after personal injury or disability claims, and for those covered by workers' compensation programs. Although some instances of overt malingering are documented by surveillance videos, most exaggerated illness behavior in compensation situations takes place because of a combination of suggestion, somatization, and rationalization. A distorted sense of justice, victim status, and entitlement may further the exaggerated sick role. Adversarial administrative and legal systems challenging the claimant to prove repeatedly he or she is permanently ill harden the conviction of illness and the individual's defense of the claim. Unfortunately, after advocating for one's injury before a sometimes doubting public for the several years required to resolve such claims, care eliciting behavior too often remains permanent. Because any improvement in the claimant's health condition may result in denial of disability status in the future, the claimant is compelled to guard against getting well and is left with no honorable way to recover from illness. Financial reward for illness thus functions as a powerful nocebo, a nonspecific force creating and exacerbating illness. Solutions require recognition that judging disability and work incapacity in others is an unscientific process and that adversarial systems rewarding permanent illness or injury, particularly self reported pain, are often permanently harmful. The remainder of the solution must be political.

译文

众所周知,在人身伤害或伤残索赔后未决诉讼中,以及工人赔偿计划所涵盖的患者中,医疗结果差强人意。尽管监视视频记录了一些明显的犯罪行为,但是在补偿情况下,大多数夸大的疾病行为都是由于建议,躯体化和合理化的结合而发生的。公正感,受害人身份和应享权利的扭曲可能会进一步加剧病态的作用。对抗性的行政和法律制度要求索赔人反复证明自己患有永久性疾病,这加深了对疾病的定罪和个人对索赔的辩护。不幸的是,在解决了这种要求所需的几年中,在有时引起公众怀疑之前提倡人身伤害之后,引起护理的行为常常仍然是永久性的。由于索赔人的健康状况的任何改善都可能导致将来丧失残疾状况,因此,索赔人被迫提防身体不适,并且没有光荣的方法从疾病中康复。因此,对疾病的经济报酬具有强大的作用,它是一种非特异性的力量,可以使疾病恶化并加重病情。解决方案需要认识到,判断其他人的残疾和工作能力丧失是不科学的过程,而奖励永久性疾病或伤害(尤其是自我报告的疼痛)的对抗系统通常会永久有害。解决方案的其余部分必须是政治性的。

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