Unbelievable! Caught up in Psych red tape

[steve55]

As I have previously posted, I have started seeing Dr Ziglar at the TX back Institute here in Plano, TX. Just last week I had completed some kind of pschological evaluation which included a 400 question questionaire.(ugh!) They said after this Psych evaluation was done, I could look forward to getting my discogram scheduled as the next step in the process for a potential ADR.

Well, I talked to the Psych doctor who says:

1. "Your 400 question pysch test came out as "Invalid". In other words, the answers were inconsistent". She said something about my not answering the questions in all honesty or not being honest with myself or something to that effect. So, I must come in for further testing because of it. I figure gee, maybe Ill get 800 questions this time. (rolling eyes) And they are stupid questions like " I like to be with people", "I have never lied", "I loved my mother" , "i like to tease pets", etc, freudian type stuff. The REALLY funny thing is that, Im pretty sure that I know what they like to see on these tests. I think I could have taken this same exact test and answered what I think they want to hear and passed with flying colors. Ive done it before and gotten hired at jobs doing it that way. I think a good result occurs if you answer each question in a positive way. You have to answer all questions that reflect you're a happy person, and that you like to be sociable, and that you like people, and that you trust others, and that you're not a loner, and yet you have to be sure to still answer certain questions in a realistic way such as "yes, I have lied before" to show you are being honest with your answers. It seems that answering truthfully is what sometimes gets you in this predicament. Anyways, in the meantime, precious time ticks off the clock as my Aetna insurance expires in march at which time I have to go on $600/mo Cobra. My employer's new insurance carrier , Humana , isnt listed on a ny websites as a ADR friendly company, and I know Dr Ziglar is one of the best there is so I plan to pay cobra as long as necessary to follow this through completion.

2. She says my last doctor's assistant wrote on my paperwork that I was uncooperative after my plasma disc decompression surgery. I was like, "Huh?". Then I recalled that about 7 days after the plasma decompression surgery, I had reported a flare up in my back which the doc's asisstant blamed on my overexerting myself too soon. All I did was wade around in the pool (but not swimming of any kind) , and went shopping at the mall, and trying some clothes (the shirts did require me to lift my arms over my head). At the time, the assistant was upset I did these things, BUT when I explained to him that I was verbally told to "resume normal activities as tolerated" , and that there was no instruction sheet indicating otherwise, he admitted that they did not yet have a post op procedure written up yet since this procedure was so new. Actually, the only post op care sheet I recieved was the generic instructional sheet they give you after a epidural or discogram. I specifically rememered this because I was so surprised that it looked EXACTLY the same as the others despite this being a surgery: (i.e. Dont drive for 12 hours,call doctor if fever, apply ice, blah blah blah). So now, I am percieved by this TBI psyche doctor as a non cooperative patient. MY GOD! Unbelievable. And I even lost my JOB at the time because my new employer at the time did not allow for sick leave beyond the normal 3-4 days we were given as a new employee. So yes, i did take my bed rest (even though i was tempted to work through it so as to not lose my job!)
But once I started feeling much better i started to resume some very basic activities. Wasnt told not to do so.

3. Since I have revealed that I am also bipolar(I have the mild form of it, bipolar 2 and my pshyiatrist allows me to take medication only as needed), she says she also needs to talk to my Psychiatrist first. Sometimes when you admit to being treated for any type of depression/anxiety condition, they start getting worried and it red flags your profile. It would have been just as easy for me to not mention anything about that so as to avoid such unnecessary extra scrutiny. Well, I guess she may also want to verify that I have always followed his directions well to see if I am likely to do the same with Dr Ziglar. Fine with me. But its # 1 and 2 above that have me a bit upset right now.

Lastly, she deems me as potentially being a non cooperative patient because when she suggested I take 15 minute breaks from work to see if this relieves the back pain, I pretty much responded with a non chalant attitude of like "yea, whatever". I mean, Ive been fighting this for 6 years and have tried physical therapy and back exercises etc, so hearing something like this given the severity of my problem just seemed kind of rediculous to me. Ive already tried all that stuff and more. Thats not what I came there to hear. I understand she is just doing her job and trying to perhaps make a helpful suggestion, but again, it seemed like a trivial suggestion in light of how long this has been an issue for me and the severity of the problem. I guess she picked up on my reaction and didnt like it and must have considered it as a non cooperative response. Besides, Im in the same pain even on the weekends when Im not working at all. So, I already know that a few back breaks or back strecthes isnt going to do anything significant, if at all.


So , here is what Im thinking. Ive tried physical therapy on 4 different occasions since 2000(its never worked, and in fact, the TBI was the very first place I went for treatment back in 2000 when this first started), Ive had the epidurals, Ive had the plasma disc decompression, Dr Peloza's discogram postively identified the disc pain generator as C6/7, and Im on hydrocordone and alleve every day, and lately its gotten worse to where I cant sleep many nights. And here they are fooling around with this Psych crap, even worse, telling me I might not be eligible for surgery because of the above mentioned issues? (Rolling eyes). Or perhaps because Im not so receptive to taking 15 minute back breaks at work? Folks, Im beyond disbelief. If it wasnt for my belief that Dr Ziglar is truly one of the very best ADR surgeons in the US, and the fact I personally liked him when I met him, I would have just given up on them and sought treatment elswhere. Who wants to be treated like this? Its humiliating and almost insulting based on what it implies. The implication is that you're either a nutcase or that you wont follow post op procedures because you dont pass some silly freudian test or because you're not receptive to a back stretch suggestion. Since when do people get refused treatment because they fail some psyche tests or for anything relating to psychology? "Yea doc, the day after surgery, Im gonna go play some street ball and do 100 push ups". (rolling eyes) . If anything, Im the perfect candidate for success given how prepared I am (Im on this board plus 2 other back boards), and how I have fully edcuated myself on back issues and ADR and what to realistically expect. I know the risks and whats involved. This is probably more self education and preparation than most do prior to their surgery.

My question is,.....how is it that after 2 years of perusing back boards like this one, I have never even HEARD OF people talking about getting Psych evaluations as a requirement for back surgery, much less anyone being told "you might not be a candidate for surgery" based on such tests. Am I the first???

Has anyone else been threatened with surgery refusal SOLEY based on issues like this??Grrrrr.

If I end up having to go elswhere to get treatment, and I have to deal with one of these psyche doctors and tests again, next time Im gonna say what they want to hear!! I know how to play that game well. Just smile and say "Yes mam, thats a great idea. Yes mam, I would love to try that". And then answer those freudian tests based on what they want to hear. Its not hard to do if you use a little common sense and stay consistent. I know this game well and unfortnately, sometimes being honest gets you into trouble.

I still cant believe my obstacle to getting treatment is some Psych doctor. Who would have thought??? I dont mind taking their Psyche tests, it just bothers me that someone could be refused treatment based on things like this.

Ok, am I overreacting here or would you folks feel the same frustration if this happened to you?

[Lisibug]

I'd be mad, too. When I applied for Disability I was sent for both ortho and psyche evaluations, but prior to both my neck surgeries (here and in Germany), I never had to either see a psyche doc or fill out a psyche evaluation. However, it could be standard practice with Zigler - I know all docs do things differently. Bertagnoli in GY puts all his patients in full body traction prior to surgery - I don't know any other docs who do that. So, I'd wonder whether this was standard practice with Zigler or whether they singled you out a) because you're slightly bipolar or b) because they think you've been 'noncompliant' in the past.

I would think that with your explanations of the 'noncompliance', that would clear things up on that front - however, sounds to me like you sure were doing too much right after your other surgery! But I'd hardly call that noncompliance and it is not uncommon. I sure wish you success and no more frustration in getting everything done before you're on Cobra. I'd be frustrated too, if I was in your shoes.

[KBear]

Steve,

I would be pissed and I was pissed when the same thing happened to me . It is standard at TBI to do a psych evaluation. I did one before I saw the first surgeon, Dr. Bradley. I left his office bawling like a 10 year old girl. He said "I won't do any surgery on you until you get cleared from psych. I know this is hard to hear about yourself. When people are depressed and have psych issues, we just don't get good surgery outcomes." And he went on and on about how I wasn't 'stable' according to their psych test. I felt like an inch tall. Then, I went and saw Dr. Zigler, and he didn't even mention the test results.

I think that some insurance companies require this, so they just do it regardless. It also probably has to do with covering their a** if you come back and try to sue and say you weren't stable enough to make that decision. Lastly, I think it is a way for them to make money. If you 'fail' then you have to do more therapy and they make more money.

I even lied my a** off on the test and failed. I didn't admit to nearly anything. I put I was happy, not depressed and only admitted to depression in the past. She ordered either bio-feedback or hypnotism therapy. I did the bio-feedback, which is breathing in out deeply for 30 minutes while someone stares at you, you are also sitting in an uncomfortable chair, and you are supposed to relax! I did that and passed, then I had to meet and talk with her. I passed and got the hell out of there.

[Cirobi]

Wow... this just boggles my mind. I didn't have to go through any of this junk. Don't they stop to think that maybe, just MAYBE some of the depression and mental things that come up on spine patients are CAUSED by the pain and aggrivation of the disability?! Me and a bunch of my college friends have gotten into a routine of posting a year in review reflection on our LiveJournals and I took a good bit of time to reflect on 2008 because it truly was a full year of wacky stuff that happened. When I reflected on it, I realized just how much happier I was to have gotten that back pain relief. I knew I had been depressed about not being as agile or able as I used to be in high school but what really got me down was knowing I shouldn't be in the state I was in. Once the problem was resolved to my satifaction (i.e. successful surgery) I found myself generally lighter on my feet and able to smile more.

*sigh*

I wish you luck in your battle with this.

~Sara

[steve55]

Yea, well, I aint gonna stick around with this song and dance for too long. If I have to, Ill go with the Prestige with Dr Peloza, he is also one of the best doctors in the US for ADR. Its almost offensive that doctors would REFUSE giving medical treatment based on psyche tests that supposedly tell them whether your surgery will be a success or not. That means they believe outcomes are based on whats in your head and not based on fixing whats PHYSCIALLY wrong with your back? If its mostly whats in your head, then why ever do surgery?

I posted a question at spinehealth website under the surgery section. I asked everyone who had fusion or ADR surgery to respond to let me know whether they had to see a Psyche doctor prior to being cleared for surgery. 80% said NO!! Many posted that they never heard of that being done. The best doctors in the world in Germany(bergnetelli and zeegers) dont do this crap either. I dont mind them doing it to help prepare the patient for dealing with surgery. Im open minded for whatever they believe will help the patient. But to potentially DENY you much needed treatment over percieved psychology issues is PURE INSANITY!! It actually angers me as it goes against the doctors code of ethics to treat people who need help. Its making me think twice about continuing with them. It leaves me with a bad taste in my mouth. Ive had awesome experiences with Dr Peloza and his team, I just might go back to them and pay a higher out of network deductible and get the prestige. They have already told me the ADR is likely my next step if the plasma disc decompression didnt work.

[steve55]

Saw Dr Ziglar today. As I started to discuss my concerns with him regarding the Psyche hassle/hold up, he quickly interupted me and said not to worry about that. He says he will expedite my discogram and ADR surgery ASAP. I was like "WOW!". I didnt expect to hear that. The strange part about all this is that this Psyche doctor just days ago told me Dr zig was agreeing with her about holding my approval up and that I may not get approved. Then suddenly, I am now told I will be expedited as soon as my Psychiatrist's report comes in (as long as there nothing majorly unusual in theh report which I dont expect).

I asked him what the deal was with their psyche doctor telling many of his patients that they may not get approved. He just said that tests show that "depressed" patients have poorer outcomes, but he said he also recognizes that people who are in pain tend to get depressed. So , not sure what to make of all that.

Given his quick and fast stamp of approval, I wonder if what the Psyche doctor said about his agreeing with her is true? I mean it was just last week that she claimed he was agreeing with her in holding me up.

So, I now wonder if he is an unwilling participant of this psyche stuff and just puts up with it, or, if the psyche doctor is on a power trip and likes to have control and enjoys threatening people with non approvals? I hate to say this, but my instincts tell me its the latter. I say this because she wasnt very positive in the way she delivered her potential denial news. In a weird way, it felt lilke she was on a power trip. You can just sense these things ya know.