A Psychologist Before Surgery?
If you question why you have been referred to a psychologist for an evaluation when seeking surgical treatment for a medical condition, you are not alone. Other surgical candidates have expressed similar thoughts. Two common misconceptions are that you are either being referred because the physician thinks you are faking your illness or that you have a psychiatric disorder. Actually, presurgical psychological evaluations are now considered a routine part of medical care for some elective procedures, much like other medical tests.
The reason psychological evaluations have become routine is because there is now a lot of research on the impact of psychological factors on the processes and outcomes of elective surgeries such as weight loss surgery or spinal cord stimulator implants. In general, studies have demonstrated that psychological and social factors have an important role in managing chronic pain and medical conditions, preparing for surgery, coping during recovery, adapting to changes during and following rehabilitation, maintaining compliance with treatment recommendations, and maintaining a healthy lifestyle. You might think of these as associated with the non-procedural aspects of a “successful surgery.” Therefore, many insurances and/or surgeons now require a psychological evaluation before you can undergo an elective surgical procedure.
The purpose of a presurgical psychological evaluation is to determine if there are any psychological factors that may impact your ability to prepare for surgery, to comply with postsurgical treatment requirements, or to adapt to postsurgical lifestyle changes. Some of the factors that can influence a successful surgical outcome are poor coping skills or support systems as well as untreated mental health conditions.
What to Expect:
Presurgical Psychological Evaluations typically include a 1 hour interview and 1-4 hours of testing. On the date of your initial evaluation, you will complete a series of forms regarding your personal background and treatment history. You will then review this information in a formal interview with Dr. Gordon in effort to get a full understanding of your concerns. You will be asked about your symptoms, medical history, medications, and other relevant factors. Testing will then be ordered and completed either that day or at another date, depending on the complexity of the evaluation. Testing involves paper-and-pencil or computerized tests and answering questions. The most important thing you can do is try your best. Honest and complete participation will help improve the reliability of the evaluation, and you will be provided with numerous opportunities throughout the evaluation to ask questions or clarify any concerns you may have about the procedure. Also, please remember to bring your eye glasses and/or hearing aids to all appointments, even if you feel you do not need them.
After testing is completed, Dr. Gordon will need time to score and interpret all of the data and then to write the formal report. The time needed can range from a few days to a few weeks. The report will then be submitted to your referring provider, and you will be notified the report is completed. You will then be offered an opportunity to schedule a follow-up feedback session to discuss the findings and treatment recommendations. Dr. Gordon prefers to have a feedback session lasting up to 1 hour with the patient, but some opt for a telephone follow-up or none at all, particularly if there were no clear indications against therapy.
Types of Findings:
A common misconception is that your proceeding with surgery is based upon getting approval by the psychologist. Rather, the psychological evaluation and recommendations are only one aspect of the total presurgical evaluation process that your surgical team will use in making their determination about your readiness for surgery. Dr. Gordon’s findings and recommendations can range from lending support to proceeding with surgery to advising against surgery due to increased psychological risk factors. Typical findings focus on identifying your personal strengths, coping styles, and include recommendations for the types of preparation and follow-up support that would benefit you most for the type of procedure you are seeking. That type of information will then help the medical team evaluate your total readiness for surgery and develop the most effective treatment plan for you. When risk factors for complications are high, treatment likely will be recommended for managing any high risk conditions prior to proceeding with surgery so that you will have the best changes at coping before and after surgery. The medical team will develop an individualized plan to support you during your treatment and make the ultimate determination regarding you receiving surgery.
A portion of the information above was adapted from Block, Gatchel, Deardorff, & Guyer (2003, p.35)