The following is excerpted from a letter sent in response to an insurance company's request for information about a patient who had filed a claim for disability payments. Details have been changed to protect the patient's privacy.
Dear Claims Specialist:
Re: Ms. -
Your claim no -
I have been a family physician to Ms. - since her first pregnancy, ten years ago. She has generally been well. In the second year of our relationship she came for seven one-hour sessions of counselling; our discussions related to her experience of hardship in her earlier life in - and to the frustrations she was experiencing in her own work as a counsellor. She showed no signs of psychopathology. I believe she benefited from the work we did and proceeded in her life with new enthusiasm and understanding. She had a second child one year ago.
This spring her husband became ill with suspected tuberculosis. Ms. - brought herself and her children for testing; she and one of her children were found to be converters and began a nine-month course of medication. Her husband was later found also to have lung cancer. He returned to -, where he died a short time later. Ms.- travelled to - for the funeral. On her return to Canada, I was able to confirm that she was in good physical health, in spite of her earlier exposure to tuberculosis.
I last saw Ms. - six weeks ago, at which time I noted that she was still working out her grief reaction and displaying depressive features. This seems appropriate under the circumstances. She is a single parent of two children, and her health and that of her children has been at risk. It is natural for her to feel depressed, confused, angry and afraid. It is natural for her thoughts to dwell on her health and on her ability to provide for her children. The life she had been building has been grievously distorted, and she is doing the only reasonable thing any mother could do in these circumstances: she is drawing back, allowing herself time to grieve, and making herself a resource and comfort for her children. For her not to take the time to work this through is a direct route to later problems and illness. It is my assessment that she is unable to fulfil the requirements of her job, and that as a major part of her treatment she should be at home.
Ms. - has not received any psychiatric medication or referral from me. She has a social network in the community, from which she has sought support and understanding. I expect that she will be able to return to work in the New Year.
Please advise if I can provide any clarification or information. Figure 1
Sincerely,
R Springate
Russell Springate, MD, CCFP