In trying to shift the language of disability, I overcompensated and missed an important aspect of secondary gain. I accepted the negative connotation of secondary gain and wanted to eliminate it rather than understand it. As I have come to realize, secondary gain is a spectrum and comes in positive and negative forms. Rather than trying to nullify the concept, I should have expanded it to comprehend how patients and providers respond to losses that come with illness.
As I will discuss in a future column, providers can measure loss far better than gain and easily miss the success of those individuals with illness who transform their physical disability into a life of achievement and satisfaction and, yes, a very positive type of secondary gain.
Dr. Pisetsky is physician editor of The Rheumatologist and professor of medicine and immunology at Duke University Medical Center in Durham, N.C.
