Dr. David B. Adams – Psychological Blog

Psychology of Illness, Pain, Anxiety and Depression

Head Injury but not Brain Injury

surgeonA surgeon seeing a patient wanted a psychological evaluation. The patient is not depressed. He simply has a back injury and is in pain.

a. Unless told that he felt the patient was anxious or depressed or suffering from some thought disorder, it appears that he is not seeking a diagnosis so much as he is seeking a sense of direction.

It may be that he has done everything that is usual and customary to manage the patient’s complaints, and, yet, the complaints persist. This is not only troubling and discouraging, it is also time consuming and something that needs to be explained.

If a patient is unimproved after reasonable standards of care have been applied, then something else is going on which has not been fully explored. This may be related to family, financial, legal or other problems.

The surgeon has neither the time nor the environment in which to explore these issues, and, indeed, exploration of such factors may interfere with his clinical relationship with the patient.

b. Secondly, “psychological” simply means a full examination of how/why the patient thinks, feels and behaves as he does. It is not the same of “psychopathological” (meaning “mental disorder”).

Securing a psychological exam is a means of completing your database on the patient and understanding why you wish/need to do next to move the case along. For most of these patients, the major issue is not whether they are depressed or anxious.

The major issues may be related to aspects of their lives of which we have insufficient information (i.e. data).

It would appear that the surgeon is indicating that he needs more information and does not feel that it is within his domain to secure those data. It does not appear that he is dismissing the patient as simply depressed or simply anxious.

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