I find it absolutely amazing that my insurance would require a psych assessment (ha! I passed) prior to implantation of a spinal cord stimulator, but no sush assessment was required prior to major back surgery. Any answers?

Poor psych assessment correlates with poor outcome (in most situations). I think it was required in this situation because the SCS requires the patient to be willing and educated about the device before implantation. If patient compliance is a foreseeable issue, the benefit of the device is minimal. Not sure if this is on the right path of reasoning...

Justin

Well put, Justin. I think it is fascinating that the insurance (Medicare?) required the psych assessment rather than the physician. See the article posted by Harrison in the Article Library on psychosocial factors and spinal surgery.

It's amazing the way these doctors minds work -- -- -- what a big benefit of having Justin on the board here http://adrsupport.org/groupee_common...icon_smile.gif http://adrsupport.org/groupee_common...icon_smile.gif http://adrsupport.org/groupee_common...icon_smile.gif

Hi, I am new to the forum but not to the back support board. I'm not a candidate for ADR but am extremely interested in it.


I believe the reason for the psych evaluation is


to see if you are emotionally stable enough to tolerate a foreign object in your body.

Carol

My findings have been that the psych eval is to see what the patients expectations are vs. the reality of what if...what if it does not do all of the things in which the patient may think the operation or major procedure promises to do, in their perception...What if there is still pain? What will you do with your life, What if this new disc in your back does not allow you to go back to work and do the things in which you thought you would be able to do after the procedure etc...

Anyhow - that is what I think they give them for. If a patient is not grounded as to the 'what ifs' then they have someone unprepared to go into it in the first place.

I am not yet a real candidate for ADR and enjoy being here too, yet I am not the most knowledgeable here...I have just asked a lot of questions as to why on the psych eval too because I needed to know why before taking one.
Thanks

Back when I was looking for a surgeon to do the 2-level fusion I was sure I needed, Doctor 90% required an MMPI before surgery. (Minnesota Multiphasic Personality Inventory)

Results are paraphrased:

Patient may be amplifying pain in order to generate attention.....

or.....

patient may be experiencing severe, chronic pain.


Well, thanks a lot for the definitive results! This is like a rorschach test for the doctor... he can see whatever he wants to see.

Wouldn't it be great if medicine was a science?

Mark

Mark: As a psychologist, I don't like the MMPI but it's a favorite test because (1) it doesn't require much time and effort to administer and (2) it generates numerical scores, so people assume it has validity. What your report indicated is that the MMPI cannot tell if pain is real (duh!) and my hunch is that the psychologist who submitted the report just took the results off a computer program and added no thoughts or judgment of his own. A good pre-surgery psych assessment should address patient coping skills, to put it most simply.

This is yet another example of the roadblocks put up by insurance companies to find any reason to deny coverage. Just imagine the folks who are not fighers, who are not capable or inclined to do research on their own behalf. I am sure this type of thing works for the insurance companies a majority of the time. While I am angry when I look back at my own experiences, at least I was able to work through them and get the treatment I wanted although a significant portion came from out of my own pocket. (With a lot of help just from this site alone)

I can't believe this continues to occur in our country daily and still health care is not a top 5 issue in politics except possibly among seniors. How can other subjects such as the display of the ten commandments and gay marriage take precedence over something that affects the health and lives of americans every day?

I better stop now or I will have a novella here. But, I completely agree with Mark above. Medecine is part art and part science. I still look back on the varying diagnosises (sp?) that I have had in the past couple of years alone, all from "top doctors" and am thankful I did not stop with the first assessment or even second assessment.

Juli: Psychological assessment serves a useful and helpful purpose in helping patients prepare for and rehabilitate from surgery. It is used for all types of surgeries, including but not limited to gastric bypass and plastic surgeries. In fact, the Texas Back Institute has a staff of psychologists who are apparently actively involved in assessment and treatment and have published a book entitled, "The Psychology of Spine Surgery." Unfortunately, some psychologists are less knowledgeable than others in this area--as with any profession.
I don't know why it was the insurance company who insisted on a psych assessment for cervie queen--again, I find that quite interesting and wonder if the other members who underwent psych assessments were referred by their surgeons or by their insurance companies.

I don't have a problem with psyche assessments, I just have a problem that it was coming from the insurance company vice the doctors. It doesn't take much to get me on my soapbox when it comes to insurance in the U.S. these days. Sorry for
the rant!

Hi Sahuro. My consultant hasn't raised any issues re. my psychological state but the insurance company (for income protection not medical insurance) physio did when I saw her before I was diagnosed. She concluded that I needed to be 'consistently reassured by everyone involved in [my] case that there is no serious underlying pathology and encouraged to increase [my] function towards [my] previous levels.' The consultant who diagnosed me said that I need either ADR or fusion and won't get back to work without surgery (and doesn't have a problem with me having either from a psych point of view - for that matter my GP said in the appeal letter to the insurer that she thought I was sound and had taken a positive attitude to taking control of my back problems) so it just goes to show how wrong these things can be when you've got a physio who doesn't perform a proper exam, wouldn't be able to find the problem even if she did and bases the psych assessment wholly on the assumption that I'm a skiving whiney neurotic because my pain hasn't gotten better after all the different treatments I've tried. The insurance co have sent the surgeon's reports back to the physio for her opinion and said that they don't think that the diagnosis on it's own counts for much because all surgeon's want to do is find a reason to cut people open.

I guess it doesn't take much to get me on my soapbox when it comes to insurance in the UK these days!

lol! Hmm, I think I can empathize! Seem's like the insurance company is not very professional if they actually made that statement "they don't think that the diagnosis on it's own counts for much because all surgeon's want to do is find a reason to cut people open"

I would think that statement alone would get your foot in the door to speak to someone at a higher level in the insurance company. But, I have thought and been wrong before.

It's unbelievable isn't it? But it gets better. It wasn't me she said that to. It was my boss. It seems they had a blazing row when my boss rang up to find out what was going (admittedly after several weeks of being asked to by me!). The irony is that the best description I can think of is they're a law unto themselves - want to guess what I do for a living?

Gillian: I only just had a chance to log in and read your post: I wouldn't trust any doctor or psychologist or whatever hired by an insurance company as an "independent examiner." These are people who literally sell their professional licenses to do the bidding of the insurance companies. What did this person base the evaluation on--interview? psych tests? I don't know enough about the British system--but if you were in the U.S., I would suggest getting an evaluation by your own psychologist--and a lawyer.