Revisión de la distorsión clínica en la Incapacidad Temporal

Abstract

Se revisa la evolución de un grupo de trabajadores que recibieron las primeras 100 altas tras la adquisición de dicha competencia por los inspectores médicos evaluadores del Instituto Nacional de la Seguridad Social (INSS) a finales de 2010 y cuyas características ya se habían publicado. Seguidos durante los 18 meses siguientes, se revisan los nuevos procesos de Incapacidad Temporal (IT), así como otros expedientes relacionados y se estudian a la luz de un elemento clave en la consulta de valoración médica de incapacidad, la distorsión clínica, entendida como la impresión subjetiva por parte del evaluador de una desproporción entre los elementos objetivos y subjetivos del caso. Destaca la frecuente recaída en IT en el periodo estudiado (roza el 40%), la constancia de los diagnósticos motivos de dichos episodios, su mayor complejidad (más edad, más pago directo…) y duración, así como la relación entre estos elementos y el grado de distorsión clínica observado en la primera consulta, que se plantea como el punto de partida natural para la gestión en consulta del posible fraude por simulación, desde el marco teórico del análisis de conducta en medicina

Behavioral analysis in forensic setting with the SAVE method

“…These, together with the integration of the various disciplines already explained, along with those inherent to any analysis of human behavior in Ethology, would be the bases of SAVE (Domínguez-Muñoz, 2021b), establishing four phases in two domains of flexible application to scientifically question the validity of a case, confirming its consistency and legal value. Created in a clinical context (Domínguez-Muñoz, et al, 2013), in its four phases the different manifestations of human behavior are specifically studied; the verbal analysis of the discourse is included in the section of Verisimilitude (Grau, 2021), called V1. That of the indicators present in the non-verbal behavior and their congruence with the verbal ones (Juárez, 2021) corresponds to Veracity (V2).…”

“…It is up to each professional to decide how much attention to pay to this issue and what conclusions to draw from it. (Domínguez-Muñoz et al, 2017a).…”

Verification of contextual information (V3) in the System for Analysis of Validity in Evaluation (SAVE).

“…They can be obtained from various sources depending on the type and circumstances of the event being evaluated. For example, in a medical-pericial context this evidence can be obtained through a complementary exploration (Domínguez et al, 2018). In other types of cases, the location of a person in a particular place at a particular time can be evidenced through the recording of a security camera or the GPS position of their cell phone.…”

Scientific basis of the System for Analysis of Validity in Evaluation: The SAVE Metaprotocol.

“…These, together with those of Behavior Analysis in Ethology, Criminology, and Psychology, are the initial theoretical bases on which the System for Analysis of Validity in Evaluation (SAVE) is designed, establishing four phases in two domains of multiple and orderly but flexible application, to scientifically question the validity of a case and provide it with consistency and even legal value when appropriate. Although SAVE was born in a clinical context (Domínguez-Muñoz et al, 2014) its main area of knowledge is the study of lying and deception, an area in which there is a large bibliography, somewhat dispersed among various disciplines, which must be incorporated as a source of academic knowledge for its use in the applied field (Domínguez-Muñoz et al, 2017).…”