Case 2
A 22-year-old Marine Corps bomb technician experienced a near miss while detonating an unexploded ordinance five weeks ago and has been unable to go back to work. He reports insomnia and problems concentrating secondary to worries about the serious accident that almost happened. Coworkers informed his supervisor that he was seen laughing and playing in the barracks on multiple occasions over the past week while off work. His supervisor shares this information with you.
2.1: Which of the following is NOT relevant for the clinician to consider in regard to the patient’s treatment plan?
A. The importance of accelerating his treatment so that he can return to work, given the critical nature of his job
B. Selecting the best treatment for his particular set of symptoms
C. Asking the patient about any recent improvement in symptoms given the reports by coworkers of his “laughing and playing”
D. The potential consequences of using various pharmacologic treatments on his ability to perform his job should he return to work
E. The current environment in the unit and the patient’s relationships with coworkers and his supervisor
2.2: Over the following weeks, the patient continues to have difficulties, and you begin to consider a recommendation for disability but remain somewhat uncertain. You examine the risks and benefits of your decision to be sure that you are making the best choice. Which of the following is NOT an important risk/benefit consideration?
A. Moving forward with disability will likely disrupt this individual’s career.
B. Successful treatment and return to work could result in further trauma.
C. Pushing the individual to return to work could adversely affect the therapeutic relationship.
D. Moving forward with disability will adversely affect the patient’s relationships with his coworkers and friends.
E. Moving forward with disability could result in a dramatic increase in other individuals from his unit claiming disability to avoid work.
