Dr. David B. Adams – Psychological Blog

Psychology of Illness, Pain, Anxiety and Depression

Compulsive and Controlling

Almost two-thirds of surgeon-instigated psychological referrals are for (correctly) suspected depression.

However, not infrequently, the surgeon has before him a patient for whom surgery went well, yet the patient is not mobilizing.

The patient returns to the surgeon repeatedly with unusual, unlikely, vague or even suspicious complaints. The patient may request more, different or specific medication. The patient may seek repeated reassurance that the surgical outcome was a success.

The patient may not respond to reassurance or attempts to put closure on care. He/she may not fully participate in physical or occupational therapies and may request second or third opinions. Often the surgeon does not know whether the patient has job skill sets that would permit alternate duty work.

In fact, such concerns are not surgical and do not fall within the surgeon’s area of practice.

Are these patients simply depressed? Many are, but some are not. Some have increasing problems emerging with their employer, former coworkers or family. Giving up their physical complaints may represent relinquishing control. The injury has become a tool with which they attempt to solve other problems of living.

The surgeon’s practice will not permit him to sit and ask probing questions that appear wholly unrelated to the orthopedic injury or surgical outcome. Indeed, the patient may be quite reluctant to talk about matters that are non-surgical even though these are the very factors that are impeding recovery and closure.

The surgeon is left with no viable option other than to leave the psychological probing to others and to focus upon the course of orthopedic care and recovery.

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