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Workplace Factors
Blame makes it harder to recover

At a glance:
  • It is important for employers to admit fault and apologise for workplace injury.
  • The beliefs and expectations of chronic
    chronic
    continuing a long time or recurring frequently
     pain patients affect their recovery process.
  • Patients in this study were asked "Who do you think is at fault for your pain?" They were given three alternatives: 'employer', 'other', or 'no one'. The resulting 3 groups did not differ in their pain intensity, or level of limitation to activity, but patients who believed someone was responsible for their pain reported greater distress
    distress
    Severe suffering, pain, anxiety or sorrow
     and behavioural disturbance, poorer response to past treatments, and lower expectations for future improvement.
Perspectives:
Employee
This study shows that holding their employer responsible for the pain and suffering caused by a workplace injury or illness increases a patient's emotional distress. Blame limits the benefit of medical treatment and expectation of recovery.

Work with your employer and others involved to resolve any feelings of blame concerning illness or injury fairly and appropriately. This will assist you and speed your recovery. 
Employer
This study shows the importance of resolving blame in workplace injury and illness as quickly as possible.

There are negative health consequences if an employee is left distressed and blaming their employer for a workplace injury or illness, whether the employee is right or wrong. Blaming their employer for their suffering contributes to a worker's ongoing level of distress and has a negative effect on both the outcome of treatment and the employee's expectation of recovery.
Treater
Many factors can influence return to work. An employee's perceptions about the attitude of their employer have an important impact on the outcome of treatment and return to work. Treating practitioners
treating practitioner
A health professional that treats patients. In return to work this may include doctors, physiotherapists, chiropractors, osteopaths, psychologists, masseurs, etc.
  may consider exploring these issues with the employee and employer if appropriate.
Insurer
Encouraging employers to communicate positively with injured workers is important.  If the employee blames the employer, the outcome is likely to be worse.  Communication about issues of blame and fault can be difficult for all involved.  However the outcome may depend on these issues being resolved.
Original Article, Authors & Publication Details:
D. E. DeGood1 and B. Kiernan1 (1996). 

Perception of fault in patients with chronic pain. Pain;64(1):153-159

1Department of Anesthesiology, Pain Management Center, University of Virginia Health Sciences Center, Charlottesville, VA 22908 (USA)
Background, Study Objectives, How It Was Done:
Previous authors have coined the term 'perception of fault' to describe the belief held by some patients that their pain and suffering was caused (intentionally or through negligence) by identifiable persons. This perception of fault, when mixed with other beliefs, can create perceptions, attitudes, and expectations which shape the patient's response to their pain.

The sense of suffering, for example, is likely worse when one's pain is not merely seen as an unfortunate risk of living, but as the result of a lack of care from others. When an injured person assigns blame, they may consequently feel they need, or are entitled to apology, compensation or justice. Blaming someone for an injury may also influence the person's response to treatment. 

This study asked people attending a pain management program if they thought someone was to blame for their pain. Their answer was then compared to their responses to other survey questions, such as how they responded to treatment and how they thought their condition would improve in the future.

The study evaluated 188 patients (86 men, 102 women), seen during a 6-month period, who participated in a pain management program based at a university department. As part of standard clinical procedure, prior to their initial visit, patients completed a pain questionnaire booklet including basic details such as gender, age and occupation. 

They were also asked a range of other questions about their pain history, beliefs and attitudes. Included was the question "Who do you think is at fault for your pain?" followed by the response options: (a) self, (b) employer, (c) other, and (d) no one.

The authors analysed the responses, using statistical techniques to determine whether a patient's perception of fault for their injury affected their pain or attitude.
Study Findings:
About one-third of study patients (73) said someone was at fault for their pain. Of these, 32 faulted their employer and 41 faulted someone else for their condition.  Patients who faulted their employer were younger on average than those who faulted others, or said no one was at fault.

There were no significant differences in reported pain intensity or ability to function between the groups at the time of the assessment.

The study analysis found that:

  • Whilst there was no difference in pain or level of function at the time of the assessment, patients faulting their employer anticipated greater levels of pain and greater limitation of activity at the end of treatment than those who chose ‘other' or ‘no one' at fault.
  • Patients who blamed their employer were not more discouraged than those who faulted 'other' or 'no one', nor were they less satisfied with previous treatment.
  • Perception of fault was strongly associated with poor response to past treatments. 60% of patients who thought their employer was at fault for their injury reported a negative response to past treatment, compared to 28% of patients who thought another person was at fault and 20% of patients who thought no one was at fault.
People who attributed blame were more likely to perceive their treatment by their employer and by the compensation system as unfair.
Conclusions:
The ‘Perception of fault' affects a person's mood and pain-related behaviour. ‘Perception of fault' was also a strong predictor of a person's beliefs about how they would respond to treatment. Patients seeking treatment for chronic pain who felt that their pain was someone's fault reported significantly more distress, expected less benefit from treatment, and were more likely to report their pain had been worsened by treatments in the past, than those who did not think anyone was at fault for their pain.

The patients in this study showed that assignment of blame to the employer is not the inevitable outcome of a work-related injury. Only about half of the patients who reported a work-related injury judged their employer to be at fault. For that half, however, assignment of fault was strongly associated with intensity of distress and a poor response to treatment.
References:
PubMed Abstract
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