MEC Connect
Tune into MEC Connect to hear MEC experts discuss the latest developments in workers' compensation. Drawing upon their extensive experience, they will share stories and practical tips that can help partners and employers discover innovative ways to create a better outcome in their program.
MEC Connect
PTSD Diagnosis Dilemma
Post-Traumatic Stress Disorder (PTSD) has undergone significant evolution in both understanding and diagnosis over the past century. In our new MEC Connect Expert Insights episode, “PTSD Diagnosis Dilemma,” our Chief Medical Officer, Dr. Fernando Branco, provides a comprehensive overview of PTSD, its progression in medical understanding, and why it is becoming overdiagnosed in modern practice.
Dr. Branco challenges listeners to recognize the critical distinction between Acute Traumatic Stress Disorder – a standard, time-limited response to abnormal events – and true PTSD, which persists beyond six months and manifests through specific symptoms that are often misunderstood. He also urges healthcare providers to be more precise in their diagnosis and shares his perspective on:
- How our understanding of PTSD shifted from purely military contexts to recognizing trauma in civilian populations.
- The fact that people living with genuine PTSD typically avoid discussing their trauma rather than repeatedly sharing it.
- The diagnostic criteria for PTSD evolving and becoming more inclusive.
- Promising treatment approaches, particularly the success of group therapy among first responders.
Listen now to hear an essential conversation about how trauma affects the human mind and gain valuable insights about the vital importance of maintaining diagnostic integrity while still honoring the very real suffering of those affected by PTSD.
Hello, this is MEC Connect Expert Insights, a companion series to our main MEC Connect podcast for Midwest employers casualty. I'm Sarah Hans and in these Expert Insights episodes, you'll hear from subject matter experts as they share practical tips and strategies on a variety of topics related to workers' comp and claims management. On a variety of topics related to workers' comp and claims management. Today, fernando Branco, avp of Claims and Chief Medical Officer, will discuss PTSD.
Speaker 2:Now let's hear from Dr Branco. Hello, thank you, sarah, for the introduction.
Speaker 2:Yes my name is Fernando Branco. I'm a physical medicine rehabilitation physician, a physiatrist, and I'm also board certified in pain and addiction and I practiced for almost 30 years before joining Midwest and I did take care of a few patients with post-traumatic stress disorder. It wasn't very common and my patients interesting enough. Now this has become quite common with patients with pain or any type of trauma, and today I'm sort of going to give you a general overview. As I was quotation mark forced to start treating a lot of these patients, I started becoming more and more knowledgeable of it in terms of understanding when this is really PTSD and when it's not To start up. We need to make a clear differentiation here. There is what we call acute traumatic stress disorder and this actually is quite common and that is a normal consequence of, let's say, a bad car accident, a trauma or some very stressful event. This person is going to have higher levels of stress. There'll be some avoidance, but that can last maybe three months, maybe maximum six months. That is really not post-traumatic stress disorder. You cannot diagnose that on the first day or month of a patient's traumatic event. Unfortunately, what we see today is that that's the case. That means let's make the differentiations between the acute stress disorder and the post-traumatic stress disorder.
Speaker 2:Historically you probably all know about this. It Historically you probably all know about this we went from completely ignoring this diagnosis you know I'm talking about like over a hundred years, let's say, during the civil war. You know this was barely noticed. It was like you are a weakling, you, you were a bad person because you went to war and now you're you're all you know strange and it was the person was blamed for and basically say you just don't have the stamina or the personality, the fiber to stand In World War I was the first time that we started noticing that this was so widespread because we had many more millions of people on this under this, and I know World War II was horrendous, but World War I was quite bad in the sense that these individuals, they stayed in trenches for long periods, they couldn't do anything. It was a very suffocating and very, very stressful environment and that's where we started noticing this. It was a very suffocating and very, very stressful environment and that's where we started noticing this. It was a military situation. That's one of the reasons that the initial name of this condition would be soldier's heart, battle, fatigue, war, neurosis, shell shock. You heard about this one Traumatic neurosis. Traumatic neurosis, of course, as we, you know, start realizing that this was not just during war, because we start to notice when people had very traumatic events like rape or abuse or being battered by a spouse. You could also have this, and that's when we start having rape, trauma syndrome, child abuse syndrome, better wife syndrome.
Speaker 2:At that point, you know, after World War II, the VA hospitals really built an excellent system to treat this and this slowly start changing into civilian society and we started realizing that we needed to also think that certain events that were not just a war could cause this. And it was an excellent idea and important because we needed to acknowledge the stress that these individuals were going through. Ptsd was finally formalized in 1980 by the American Psychiatric Association and has been evolving quotation mark for a long time and, to a certain degree, in a good way and to a certain degree in not such a great way. In some ways very good because we want to acknowledge everybody that can be like. We have our first responders, police officers, firefighters, and these are individuals that are really they're not in a war but they are under a lot of stress, and other individuals that you know that witness horrendous acts or are inflicted horrendous trauma. That means we need to open it up.
Speaker 2:Unfortunately, what I've been seeing for the last decade or so, where this diagnosis in the criteria has becoming more and more vague and becoming a little too inclusive and that sort of you know, like everything. When everything is a diagnosis, then nothing is the diagnosis. It's like almost any issue, right. Then nothing is the diagnosis, it's like almost any issue, right? You dilute the idea. If everything is that, and that's something to keep in mind with post-traumatic stress disorder With this new criteria, unfortunately, now we say that 8% of the US population have PTSD, that I have a hard time believing it. In terms of using the correct way to define it, very common symptoms that you're going to see in this syndrome will be intrusive thoughts. That means you can't control it. You know you'll be trying to have a good time and constantly these thoughts and images from the trauma are invading you.
Speaker 2:You also have the nightmares. That means you wake up in the middle of the night and then again this is when things start getting gray in here. It's like when a psychologist or a doctor is asking questions, says, do you have nightmares? And the patient will say yes, I have nightmares. Well, we all have nightmares, it's just normal. But the nightmares have to be about the have nightmares, it's just normal. But the nightmares have to be about the trauma. They have to be repetitive, they have to really bother you in terms of waking you up. You were in a terrible state. It's not just having a nightmare, and unfortunately that's when I think things start getting a little out of hand. There's also the flashbacks. I think you guys, I think the best way to remember is you know, I'll throw a movie here, born on the Fourth of July, and you see, these guys, they're all vets and they're commemorating Fourth of July and every time there was fireworks they all kind of tremble in there and that's typical because obviously they associate that with the bombs and everything else they went through. That's a part of the flashbacks.
Speaker 2:These patients, they will avoid these traumatic events as much as possible and that always was very interesting to me because I had several patients that I treated that they were labeled PTSD and they couldn't wait to talk about whatever trauma they went through and they wanted to talk over and over and tell everybody what had happened to them and how terrible it was, in general, people with PTSD. They don't want to talk about the trauma because they live through that and they don't want to think about it again. They don't want to relive it and that is one of the main factors in here. That means if somebody is constantly talking about their trauma, I'm not sure how traumatized they are, because it should be pretty painful. Of course it's different if you're talking to your psychologist or your therapist and you want to work through the trauma, but not telling the whole world and repeating it multiple times. That is not therapeutic and that is not PTSD.
Speaker 2:This person is very hypervigilant. That means that they become extremely aware of the environments. That's one of the reasons that they become withdrawal and they try to avoid contact with people. As you can see, a lot of this you don't really see in the people that generally get diagnosed with PTSD. Of course, there'll be sleep disturbance with this. How can you sleep well if you're constantly having the same repetitive, recurrent horrible dreams and you're in a state of guilt? Or you know, because remember that people that go through trauma there is a lot of guilt involved. Even if you were the one that was the victim of the trauma, people have a tendency to even create guilt over that.
Speaker 2:In terms of the treatment of this condition, it's a tough condition but we know that there is some good psychological treatment. Psychotherapists can do this. They'd be a psychologist, a psychiatrist or even a social worker that can work in some cognitive behavior therapy. One of the most successful treatments for this condition is group therapy. I have seen great results with first responders, emt, firefighters and police officers and they have group therapy patients that overcame this condition. They can be excellent to lead these groups and it's one of the most successful interventions you can have.
Speaker 2:If I can give you a summarization of this and to remember from this topic, please realize that this is a complex, difficult issue. It's being overly diagnosed. Make sure that we're not labeling a patient with PTSD when it was too early to diagnose or it does not fit the current criteria and realizing that this criteria is becoming a little more comprehensive to a certain degree. And if you want to know a little bit more about this topic, we do have a webinar that I presented on this. That is a little longer and hopefully this can be helpful to you. Thank you.
Speaker 1:Thank you for tuning in to MEC Connect Expert Insights. At MEC, we focus on what matters most worker recovery and better claims outcomes. Our skilled people, proven processes and innovative technology achieve measurable results and creates lasting value. We hope you found Dr Bronco's insights on PTSD valuable. Stay tuned for more from MEC Connect and more expert insights. Thank you.
