Why is it required to have a psychological evaluation prior to surgery?
Two very good reasons for this evaluation:
- Insurance Requires It – Most major health insurance companies like United Healthcare, Blue Cross Blue Shield, Aetna, Cigna, Humana, Medicare, etc. realize its important and usually require a pre-surgical evaluation to be complete by a licensed professional therapist before they will approve certain surgeries.
- Quality of Care – More importantly, your entire team of physicians, nurses and other practitioners want you to maximize your success – to achieve the intended results, become a healthier person and improve the quality of life to the greatest possible extent. Not only do they want to make sure you are physically fit for surgery but your team also wants to make sure you are mentally fit for surgery as well.
What is included in an evaluation for pre-surgical clearance?
Behavioral assessments involve two parts:
- Behavioral Testing – Patients will provide demographic information and will take a series of exams to help identify your strengths. It can also help find areas where you might need help and support before and after surgery. Your therapist will evaluate and score the exams you completed which helps identify topics to discuss in the clinical interview process.
- Clinical Interview – Patients will schedule a one-on-one clinical interview with one of our therapists. In a relaxed setting, the therapist and the patient will connect through a HIPPA-compliant audio-video platform to discuss the exams and goals with surgery. The core parts of the clinical interview include reasons for seeking surgery, historical and current behavioral patterns, understanding of the surgery and its associated lifestyle changes, social support and history, and psychiatric symptoms (current and past). As each of these domains is addressed, your therapist will function as an assessor collecting data, an educator providing information, and a therapist enhancing motivation and managing the emotions often encountered during the evaluation.
Should I be concerned that I will fail the evaluation and not be able to have surgery?
It is important for you to understand that most people seeking a life-altering surgery are usually psychologically normal and do not fit any specific psychological profile. The therapist’s main purpose is NOT to find underlying problems and conflicts that might have led to the underlying condition, but rather how to help you move forward with how to be successful post surgery. Our therapists who perform these evaluations specialize in health psychology, and as such, are looking for ways to help you prevent disease and promote health in the future.
If I am being treated for a mental illness does this exclude me from having surgery?
There is really no specific personality pattern that predicts success or failure after surgery. Many studies have examined depression, bipolar illness, history of childhood sexual abuse and even severe mental illness or eating disorders as potential predictors of failure to reach goals after surgery.
Results have shown no clear-cut predictors of failure. As an example, about 40 percent of candidates for bariatric surgery have a history of depression. Often, the depression is being treated with medication and/or counseling and is well controlled. This situation almost never presents a problem after surgery.
There are, however, behavior patterns which suggest greater need for follow-up after your surgery. For example, grazing, or non-mindful snacking and nibbling on high-calorie foods between meals can be a problem if not identified and stopped once you have had a bariatric surgery. It is a pattern that significantly reduces your chances of success. This gives the provider a chance to recommend further follow up so you can be successful with your procedure.
Will normal episodes of anxiety or depression prevent me from having surgery?
Most people at some time in their lives have experienced psychological problems. These episodes are typically treated with medication and/or psychotherapy. Normal anxiety and depression would not disqualify you for surgery.
I have been requested to take a pre-employment behavioral assessment. Should I be concerned?
Organizations are increasingly using behavioral assessments as part of their due-diligence prior to hiring an individual and our process and use of technology makes it easy and convenient for the company as well as the prospective hire. There really are no right or wrong answers so candidates should be at ease that the company is just trying to learn more about your personality. Rather than try to uncover specific flaws in a candidate, these assessments are used to ensure that there is a proper fit for the specific role, team, and organization. Hiring for or accepting a position is an important decision and commitment, so all parties involved should be confident that they are comfortable from a behavioral and mental perspective in addition to a traditional HR process.
Should I feel uncomfortable being evaluated by a mental health therapist?
Although patients often are hesitant and uncomfortable with the notion of seeing a mental health therapist before surgery, the information discussed during the clinical interview is critical not only for assessing their appropriateness for surgery but also for enhancing their success during the post surgery adjustment. As uncomfortable as the idea may seem, many patients report after the interview, how valuable it was for them to examine the issues raised.
What if I am currently being treated by another mental health provider?
If you are currently being treated you still need to be evaluated by an independent mental health professional that is trained in conducting pre-surgical evaluations. Therapist trained in the procedures we address will know exactly what is needed not only by your insurance company for determining approval for surgery but will also know what your program is looking for both pre and post operation from patients. It would help, however, if your current provider would write a brief letter supporting your decision to have the surgery.
What if I am taking medication for a mental or emotional problem?
You may be asked about current medications that you are taking. For the most part you will continue taking the medication after surgery. Many psychiatric medications cannot be abruptly stopped. However, if the medication is time released you may need a substitute medication to be prescribed by your treating physician. Please seek advice from your current physician prescribing the medication and speak to your surgeon’s office on how to instruct you about making changes or substituting medications in conjunction with your procedure.
What happens during and after my clinical interview?
During the interview process your therapist will want to know about your family and social history, any medical or psychological concerns you may have and your reasons and motivation for seeking the desired surgery. You will also be asked about your past and present behavioral patterns, your level of activity and exercise and your current family and social situation. The therapist can often answer questions you might have. For instance, some people are fearful of the surgery itself and may be able to benefit from stress management techniques. There is evidence that people who are relaxed prior to many types of surgery not only heal faster, but also have less post-operative pain. The therapist may be able to guide you toward techniques which may help with this. The therapist can also help you understand that some feelings that often occur post-op, if they occur at all, will usually be short-lived. And, if you feel the need for a referral for counseling, please feel free to ask. Just remember, the therapist is part of your “safety net” after your surgery whose primary focus is your ultimate success.
After the clinical interview is complete an evaluation is created and the results of the testing are documented and sent over to your surgeon’s office. If any concerns need to be addressed, your therapist will discuss them with you prior to your evaluation being sent over to discuss the conclusion of the assessment.
How will I know if I passed the evaluation?
The evaluation is not about passing or failing. The process identifies potential problems that might cause you difficulty if you have surgery. If there is a concern, it will generally be discussed at the time or after your clinical interview. Following the clinical interview a behavioral assessment report is provided to the surgeon. Your surgeon’s office may use this report as part of your pre-determination insurance process to get approved through your health insurance. Your surgeon may use this evaluation to make a decision as to whether he or she will proceed with the surgery. The evaluation itself does not qualify or disqualify you for surgery.
Can I receive a copy of my evaluation report?
You can receive a copy of the evaluation by contacting us and requesting a Release of Information form.