Question:
The whole psych. eval issue is discrimination at it's best.
After my recent psych. eval. I realized that smokers don't have to have a psych. eval.(P.E.) if they get lung canser and need chemo;nor do alcoholics need a P.E. for dialysis if their kidneys shut down, etc. Why do those of us struggling with food and weight need P.E.'s? Does this not imply that we are "crazier" then the rest? Why lable us? Gos I'm so tired of back door crap. Anybody else think this is discrimination-please let me know. Thanks. — MaryLisa D. (posted on November 26, 2002)
November 26, 2002
No, I don't think it's discrimination. The surgeons and/or insurance
companies that require psych consults do it to weed out people who exhibit
behaviors that would not be conducive to a successful outcome from the
WLS.
<p>
It has nothing to do with our mental state. By screening out certain
individuals, doctors can reduce their patient workload to those who he
truly can help - thus allowing for shorter consult-to-surgery times. On
the insurance side, it helps to hold down the insurance companies costs
(this is not a cheap operation) and that helps to keep the rate increases
for premiums lower.
— John Rushton
November 26, 2002
Mary, i don't think there is anything wrong with having a psych consult. I
think EVERAYONE should be required to do so prior to surgery. Alot of
people aren't repsonsible enough, aren't emotionally ready or may have food
addition problems. This is ELECTIVE SURGERY...This surgery is ALSO A TOOL!
You can gain all the wieght back if you don't use the tool your surgeon
has given you. If you are not 100% commited to changing your life and your
decision making process, this won't work for you. That is what the psych
evaluation is needed. If you are emotionally or mentally insecure, you
could be getting yourself into something way over your head! Good Luck to
you.
— heathercross
November 26, 2002
yes, alcoholics DO go through EXTENSIVE counseling before they are given a
new liver if they have destroyed theirs with alcohol. I can not blame docs
or ins. companies for this requirement. I actually think it is a good idea,
and MORE surgries should have psych evals before they procede with surgery.
— Vicki L.
November 26, 2002
Not discrimination in my opinion. A psych eval isn't only to determine if
you are capable of making this decision but more so to make sure you are
emotionally ready to deal with it and all that comes - the good and the
bad. It's got nothing to do with being crazy or not.
Trust me it can turn your emotionaland physical life upside down, losing
weight so rapidly.
Chris D.
— zoedogcbr
November 26, 2002
I TOTALLY agree. It was a requirement of my ins, not my doc. Mine said I
was a marginal candidate (might be moderately successful), but that I would
not be involved in support groups. LOL! Further, I "imagined"
myself to be in a happy marriage that would not create problems for
aftercare. Oh? Then 1 yr later, when my husband had it, it basically said
the same things. Moderate, no support groups, imagined himself in a happy
marriage. Soooooo, very interest. There may come a time when we do not do
4+ live groups per month, but not for the last 8 yrs. We are both STILL
imagining ourselves to be in a happy marriage--god thing we are both
delusional, then. Since I m eet a lot of pre-ops, I often have a feel for
whether they will be successful or not. I'm wrong more than I'm right.
The pre-op person is NOT the post-op person. Life changes, character
emerges that was not visible pre-op. It's amazing. I SO totally agree
with you!
— vitalady
November 26, 2002
i personally had an AWFUL psych eval and the lady even turned me down so i
went to someone else and got a second opinion, passed and now have a date
jan 27 :) i think the eval is a good thing tho there ARE alot of people who
arent willin to stick with the diet or are just wantin it to be thin and
dont wanna follow orders, its good that some of those people can be weeded
out, for their sake and also for ours who are serious about doin the right
thing, imagine the wait we would have if they let everyone who wanted the
surgery have it lol
— christine S.
November 26, 2002
I don't know that I'd go so far as to say its discrimination...but I'm
certainly not one of those people that thinks that a psych eval is
necessarily a good thing, for a few reasons: 1. There are very few
psychiatrists that are actually trained in weeding out the issues that the
doctors/ins. companies are looking for; and 2. I, personally, do not
believe that a psychiatrist can really get to know someone in the short
period of time that is allotted for a psych eval. I think that there ARE
people out there that the surgery wouldn't work for. But I don't know that
I want a psychiatrist that doesn't know me making that decision for me --
it strikes me as far too paternalistic. My point is simply that if we are
going to accept psych evals as an integral, necessary part of the process
(which, again, I'm not sure they are)...we need to train our psychiatrists
better.
— Tamara K.
November 26, 2002
To comment to Tamara's comment, you should either (1) see your OWN psych.
if you have one and (2) if your dtr is in the business of doing WLS and not
some newbie or flyby night dtr, he should have a long standing relationship
with several psych. that he can refer you too. My, dtr, Dr Rivera, has
been getting Dr Leitman's clients for years and she is pro-WLS (if person
if responsible & emotionally mature) and very educated. I will go see
her again, a few months down the road if I encounter any depression.
— heathercross
November 26, 2002
Maybe because I'm a medical professional, I see this a little differently
from some. I don't think it's any more discriminatory than the EKG, chest
x-ray, blood work, etc. Since this is such a drastic, permanent life
change, it only makes sense to ensure that this person is a reasonably safe
risk. You don't operate on a person who is physically so
"unbalanced" that he or she may die on you; I wouldn't want to
operate on someone who is mentally unbalanced, as well. You want your
patients to do well. You also want to avoid being sued as much as possible,
and we are in an extremely litigious society. Imagine someone having WLS
and at some point down the road, committing suicide. It might have been due
to something totally different, but some family member is apt to sue
"because Mom was so depressed that she couldn't eat Hershey Bars after
the surgery" or some such. Or suing because they are not totally
satisfied with the surgery, having had unrealistic expectations. Some
people have pathological personalities and are a health care provider's
nightmare. If I were the surgeon, I would wish my patients to be properly
medicated and monitored, if possible. A *lot* of what we do in medicine
today is "CYA." People will sue over *anything*. I know that
medical malpractice can and does happen, and that some people definitely
*should* sue. Lots of others, however, are looking for the gravy train.
I've known of people to sue in hopes that if they sued, the hospital would
drop their bill. And I don't know if this is still common, but I've known
of plastic surgeons to require psych evaluations before some cosmetic
surgeries. That's my take on it, anyway- the surgeon wants the PE just as
he does the ABG, EKG, labs, chest x-ray and for the same reason- something
he didn't find may come back to bite him, later.
— Susan A.
November 26, 2002
I breezed through mine: yes, I understand, no I haven't had any traumatic
life events (even if I have, what does that have to do with this?) etc etc.
I was done in 15 mins and was dismayed over how much it costs (my surgeon
doesn't use a person in network and to go out of network would have taken
forever). I realized that some of the questions I could have elaborated
on, but I wasn't there for treatment, I was there for evaluation.
— marlene O.
November 26, 2002
Might as well get my two cents in here.
I agree that part of the evaluation should be to see if a person is
emotionally ready for the changes and the lifetime committment.
On the monetary side, since it costs anywhere between a total of 15000 and
30000 for the surgery. I don't know any company willing to invest that in a
longshot marginally successful procesure.
Insurance companies are for profit.
My therapist was pro WLS from the beginning. Unfortunately she is no longer
in the the ins program. I have a new one finally. Not sure how this one is
going to be.
— snicklefritz
November 26, 2002
They may not require chemo patients to have a psyche eval but they often
require them to start counceling. My aunt had to the entire time she was
receiving cancer treatment. They go thru a lot - personally and physically
and this helps to ensure a more mentally balanced patient, hence a better
able to battle patient. I don't think it's a bad idea - but I have to
biasedly admit I'm quite relieved I didn't have to have one!
— [Deactivated Member]
November 27, 2002
Hi, I needed a phyc eval also to proceed with WLS. The Doc told me that
there is no links to obesity and depression or failure in this operation.
The thing they were trying to screen was for those who wanted the surgery
for cosmetic reasons and to make us aware that there are a lot of emotional
issues that will be delt with after WLS. Lets face it, we are
discriminated against probably more than anyone else in the world. That
has put a lot of emotional scaring on us as human beings. Good luck
— Brooke B.
November 29, 2002
Wow...rough topic. I really do not feel that this is a discriminatory
issue. Our surgeons have thier own "team" they work with.
Nutritionist, psych doc, etc., all work with the group so there's no going
anywhere else to have it done and the psych doc is traied specifically in
eating disorders/food issues. Acc'd to the info I have read from our
doc's, the psych eval is not only to see if there are any significant
psychological issues, but to also evaluate for eating disorders (which
usually won't benefit from surgery). =)
— Kim D.
November 29, 2002
I don't want to start a war, but I couldn't agree LESS with you. People who
have lung cancer, who have kidney failure that requires dialysis, and other
immediately life-threatening illnesses don't have to have psychological
evaluations because they'd be dead soon if they didn't get treatment.. we
don't require gunshot wound victims to get domestic violence counseling
before we dig the bullets out, do we? It doesn't matter if people
"caused" their illnesses through drugs, alcohol, smoking,
or food, we all deserve to get medical treatment that improves our quality
of life. Those of us struggling with food and weight typically are dealing
with a complex web of self-esteem, health, addiction, social support, and
other issues. Surgery doesn't solve any of those issues, and can actually
make them worse; our surgeons need to know that we are not going to crack
from the psychological strain of the huge changes we are going to have to
make in order to succeed, and they need to know that we are actually
committed to real change (because there's no point doing the surgery if
you're going to keep eating the way you're eating pre-op). <p>We are
not crazier than anybody else; I think that most people have, to one degree
or another, coping mechanisms that work for them and that keep them sane.
Unfortunately, any addiction (cigarettes, food, alcohol, drugs) will deaden
the pain of emotional issues while masking the real problems until they
blow up in your face because you can't keep a job or perform basic life
functions. <p>Most of us, myself included, did not get to
super-morbid obesity by virtue of physical/metabolic problems alone (though
there are some of us out there, I'd put the number at less than 5%). We got
there by making poor food choices, by choosing not to exercise, and by
using food as a medication, along with genetic predisposition to efficient
metabolisms that happily sock fat away to get us through the next famine
(which never comes). After surgery, you cannot use your favorite medicine
to make the pain go away any more... how are you going to cope with that?
Are you unstable enough that you might get addicted to drugs, alcohol,
spending, sex or gambling? Many, many of us trade one addictive behavior
for another after surgery, with disastrous consequences. I did it and
ruined my credit in the first 8 months post-op... I just could not stop
buying things. I'll be paying that off for a long time, and it forced me to
finally deal with my problems head-on. It was painful, but I'm glad I did
it and since I've started tackling my issues, my entire life outlook has
improved.<p>I am really concerned about your anger. Most of our
surgeons are not in this for the big bucks, because WLS is NOT big bucks...
the before and aftercare is extensive and is usually included in the
surgical fee, which is only a small part of the total cost of surgery, and
insurance reimburses only a fraction of the surgeon's fee anyway. Our
surgeons want us to succeed, and one of the imperfect, but potentially
helpful, ways to evaluate whether or not you'll survive the surgery and
immediate recovery period, and then succeed in losing most of your excess
weight with the surgery as your tool, is to evaluate your psychological
health. They evaluate our hearts, lungs, and blood chemistry too, for the
same reasons. Don't forget that as much as we may feel that bariatric
surgery saves our lives, we were not going to die in the next week or month
without it. It's ELECTIVE surgery, unlike bullet removal, lung cancer
treatments, or dialysis. And finally, for what it's worth, many cancer
patients, most alcoholics and drug addicts, and many other people who
present themselves to the medical system with life-threatening illnesses
caused by "lifestyle choices" are compelled to undergo
psychological evaluation and/or counseling after their immediate health
crisis is resolved. So we're hardly the only ones in this
boat.<p>There's my quarter's worth on this issue. Feel free to email
me personally if you want to keep discussing this. I know that we are
discriminated against in many ways, but there's value in choosing your
battles carefully, and I don't think the anti-psych eval crusade is the
best use of anyone's energy. Let's work on getting everyone who is eligible
for this surgery and who wants it adequate insurance coverage by changing
the laws so that insurers have to cover WLS... THAT'S a valuable effort
that could make a real difference to many people right now. I'd bet you
that most people who want to have this surgery but don't have insurance
that covers it would sit down to the psych eval in a flash and without
second thought if they found out that their surgery would be covered.
— Julia Z.
November 30, 2002
I understand how you feel. I think its discrimination that insurance
companies can refuse to acknowledge obesity as a disease and then refuse
access to treatment. I understand its money based, but its still
discrimation when you have studies showing this is a disease with a less
than 5% chance of self treating through diet, exercise, and even diet
drugs. However, on the psych eval we're not the only ones. My doc (NOT
the insurance) requires a psych eval as part of his pre-op testing before
he does cosmetic surgery. I had one in order to have my tummy tuck &
lipo done. So in that way, no I don't feel its discriminatory. I think as
long as its a situation where we're not in the ER dying. If we're facing
changing our lives drastically, be it via WLS or tummy tucks or face lifts.
Its an understandable degree of protection for both us and the doctor to
take. (By the way my doc is out of Mexico, so its not just a US thing.
Plus she's a full time member of his staff.)
— Shelly S.
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