I had to recommend delaying someone's surgery

I have been working very part-time doing pre-op Psych evals.  I can't go into any detail because of confidentiality, but last week I had to recommend that someone undergo counseling and attend the pre-op classes before being approved for surgery (normally the classes are done after insurance approval, but this person really did not understand what they were going to do to her body or what her responsibilities would be... she really thought that she would be able to eat whatever she wanted after surgery).  I am confident that it was the right decision both from a professional standpoint and based on what will give her the best chance to be successful with the surgery, but I didn't expect to feel so bummed (knowing how disappointed and frustrated she will probably be).  Sigh...

Lora

it can be hard to do the right thing. But good for you for doing it. She may not agree, but you are helping her to not damage her body or be disappointed with the results

I have to say that I did not fully understand what they were going to do to my body , yes I knew intestines would be bypassed and rerouted and stomach cut, I watched videos I looked at pictures etc. I still asked the questions if it was a problem to have a colonoscopy !!! ( how stupid is that) now I consider myself pretty medically astute BUTTTTT I just couldn't wrap my brain around this whole thing. I understand much more now . I must say that I did know the the "eating" portion from the good education that my docs office provided and because 2 daughter's and 2 nieces having this surgery.
I remember 7 years ago when I was in a BAND support meeting and one of the ladies there asked how much of her stomach was cut when she had her band because she was worried because she was hungry and could eat whatever she wanted ( she had not had a fill) but she thought she had some sort of "combo surgery", we had to go get the doc because she was so confused as to what was done to her.
I am sure your client was pissed by your recommendation, but you know in the long run it will be better for her.
I don't feel we need to know everything about this surgery but we sure as hell need to know that we can't eat everything we want !!!
You did the right thing

I held a position as you so understand your personal feelings for others in  regards to outcome of an eval.  The patient must have a good understanding and what their responsibility will be to be successful.   I have close friends use surgeons fairly new to Bariatrics so they did not get NUT, support, or good guidelines.  Thus they have gained most if not all the weight back.  I had the lap band 3 yrs prior to this recent RNY so had some idea of what I would be converting to.  I'd attended support group for 3 yrs so I listened and learned about the pros and cons of the different types of  surgeries.  I have friends going back as far as 1991 that had gastric bypass and watched their journey.  Plus, I'm one that reads and researches.  This type of major surgery should not be taken lightly since it is life long.  You did the right thing.

You feel bummed because you know what the surgery has done for you and others on this board.  You know the sucess it can give, but you also know the issues.  You know what it takes to have sucess and you know you can have 'failures' even if you are following the rules.

Plain and simple, you did the right thing for the patient.  That is what your job is.  Hopefully she will learn what she needs to and come back for a re-eval and you will see a difference.


Sarah

 I remember when I was going through my lapband education, the psych evaluation was mainly about do we know what we are getting into, do we know how we will have to eat, etc.  The doctor said I knew more than any he had ever done.  (Still failed at the surgery but I do believe the band failed me I didn't fail it.)  I had read many books concerning the surgery and had been on OH for a while.  I think OH helped me better than any of the pre-op education I had and I know more than the books I read.  Now with the RNY I knew going into it what I had to do to be successful, and me and the psycologist didn't get along at all, we had personailty clashes big time.  She recommeded that I have more counseling prior to my surgery and I just told her there was no way I was doing more with her and the program didn't allow you to go elsewhere.  Needless to say I told the surgeon and I told him what I thought of her, too and he went on and did my surgery but she did sign off on it.  It was a requirement that you had to see her once after surgery so I did but I just walked in said I am here and I am leaving.  I don't recommend anyone do this but I had a very bad experience with a doctor years ago and one thing I know counciling, if with the right person, can be a great help but with the wrong person it can do more damage than good and I wasn't staying her long enough to have the damage done.  

You can only act in what is the best interest of your client.  I don't think there is anything wrong in pre-opt classes prior to approval.  Actually, I think it is a good think.  She still has the opportunity in attending the class and learning as much as she can.  I don't think this surgery is for every one.  There is a lot to keep track of and do to be successful.  If she can not do it, you might be saving her from a lot of other on going medical problem due to lack of follow through.  It sounds like you are really good at what you are doing!

I think I understand your feelings.  Several years ago I volunteered as a guardian ad litem with the juvenile court and I had a case in which grandparents had been given temporary custody of a child and mom wanted her child back.  I really liked the mom and I could really relate to her.  I really wanted her to get her child back.  But when we went to court, I had to recommend the grandparents keep custody for a while longer, while mom continued to get some treatment she needed.  I really agonized over it.  I do believe I made the right decision, and in the end it wasn't up to me who got custody, it was up to the judge, but my recommendation did carry a lot of weight.

I'm sure this person will be very disappointed, but hopefully in the end she will realize it was in her best interests.

I wish to God that my surgeon required a pysch eval in 2002 when I had my first WLS.  I truly believed that I would be able to eat whatever I wanted and still lose weight and keep it off.  Part of this was due to the unrealistic expectations that I got from listenting to other new post ops who had the same expectation.  Back then my surgery was sold as the miracle cure, at least that is how I heard it.  I belonged to other message boards and would see recipes posted like the Krispy Kreme bread pudding recipe.  I went to support social functions where the potluck table was laden with desserts, breads and other goodies.  We went out to eat monthly to restaurants and ate our hamburgers and sandwiches.  One person in that support group has had THREE revisions!  Others, including myself, have had at least one.  We gave each other advice on dealing with the loose stools and foul gas smell.  And I thought this was normal.  
I don't blame anyone.  In 2002 not as much was known and I am happy to say that these days people are much more educated, including myself.
If I had been required to have an eval then I am sure I would have failed it.  And it probably would have been the best thing that happened.  I might not have needed a revision 8 years later.

In your assessment of the client, you did the right thing. As long as your opinion was objective, stand by your decision. Lots of folks that are not ready. It's not like she was denied permanently, perhaps her approval for surgery will be postponed a few months.