Social labeling, stereotyping, and observer bias in workers' compensation: The impact of provider-patient interaction on outcome.

When injured workers with chronic musculoskeletal disorders are viewed through the narrow lens of the biomedical model, the role of situational factors is not acknowledged, and their illness behaviors and delayed recovery are often attributed to personal weakness or a desire for secondary gain. This leads to a tendency toward blame and the application of stigmatizing social labels. An overt or implied social label that carries a stigma can set into motion therapeutically counterproductive biases in social perception within the provider-patient relationship. One of most powerful of these has been called the self-fulfilling prophecy, in which expectancy-driven behaviors of the clinician, case manager, or insurance representative can subtly direct the patient to behave in a manner consistent with expectations. Justification for an attitudinal shift among providers of workers' compensation services is proposed, along with application of the biopsychosocial framework of health psychology to the problem of delayed recovery in injured workers.