Question:
Has anyone else suffered mistreatment by the psychologist who did the pre-op exam
I was required by my surgeon--my former surgeon--to see a particlar psychologist who does research (on predictors of WLS outcomes) at the teaching hospital where he also has his practice. The exam was an unusual 4 hours ($800.00 worth) in length. It included in-depth personality tests, and IQ test (!), and more. Since I work in the same field in a different role myself, I knew this was unusual and excessive. I also supected that each patient was included in her research, and that is why SO much testing of all those factors was included. The IQ test was supposedly "to make sure our patients can read", although they knew I had a college degree.I asked the doctor and psychologist if a shorter exam was possible, due to the cost, and also whether an afternoon appointment was available, since I work nights and would be exhausted in the late morning. Later, when I realized that she intended to send the entire 4 page report with detailed history and test results to the MD, I asked her whether this was absolutely necessary, and whether she could simply tell him in a letter what he NEEDED to know for my care, due to confidentiality concerns. (As it happens, although I live an hour from this hospital, some of the residents from there do training at the hospital where I work, and I did not want them seeing my detailed history,IQ, etc.) She mandated that I seek counseling due to a long-ago history of sexual abuse, and despite my resentment over not being allowed to decide for myself, I did it. (And--surprise--the counselor is wonderful, and I think I will stay and work with her. I told her my whole life story in the second visit, LOL.) However, the psychologist never called me to tell me the findings from her tests, nor e-mailed me, either. When I arrived for my appointment to see the entire report, it turned out she had --WITHOUT MY PERMISSION--gone to the surgery team--no doubt including whatever residents were on duty-- and urged them to turn me away as a patient because I had excessive confidentiality requirements! She also accused me of being excessively controlling, trying to change all the usual procedures from day one, and of having suspect reasons for using that particular hospital for my care despite confidentialty needs.(I did have particular reasons--he is the only MD near me who does the LAP RNY, and by the time I realized the residents I worked with were there, I had already waited many months to see the MD. And by the time I realized this woman was a control freak with an anger management problem and a serious vengeful streak, I had already invested $800.00 and many months in her and the MD she works with!) This woman, who hardly deserves the term psychologist, because her clinical skills outside of testing are so poor--abused my trust, and violated my confidentiality. I don't know whether she felt threatened by me or what. I admitted I had a high IQ, and maybe she threw in the test to be sure, which would indicate it WAS an issue for her. I also work as a nursing supervisor in a psychiatric hospital, so maybe she felt threatened by my awareness of the behind-the scenes stuff and nervous about possible litigation over confidentiality later on. But the way she went about resolving it was cruel, unethical, and extremely controlling. She included a good deal of pure speculation in her report, including that I probably had "interpersonal difficulties" (with whom? her? you bet I did!)and so on. I am appalled that she is the person who is screening applicants for surgery. Could it be that she thought a 270lb woman with an abusive childhood background ought not to be making so many demands or be so sure of herself? I did get the feeling she felt somewhat condescending toward obese people. For example, she concluded that there must be "mre you're not telling", and stated categorically that I could not POSSIBLY know myself well enough to trust myself to seek help with the post-op adjustment should I have trouble...As she has probably never been obese, one wonders why she went into this particular area to practice. (For the pschologically savvy, my MMPI-@ and other tests were well within the normal range, showing only a tendency to try to meet expectations of normality under the testing, a tendency to be cautious about trusting, and a creative, imaginative streak. Period.) Regardless of her motivations, she was way out of line in her behavior, and has done damage to my trust to the point I hesitate to have the surgery for fear of encountering someone else, who like her, has an agenda, and does not have my interests as a priority. I am writing to WARN YOU others about professionals like this, and to seek support. — [Anonymous] (posted on November 30, 2000)
November 30, 2000
Well, Bless your heart! Geez, isn't what she did unethical? Can't you
call her on it? That was an outright abuse of trust and CONFIDENTIALITY!
Personally, I want to be able to go to the doctor, surgeon, psychologist,
psychiatrist, counselor, nurse, etc...without someone else's baggage (just
my own, thank you very much!). I am here to talk to if you need
support...and, I will be praying for you. I know it will be hard to trust,
but..talk to your surgeon and talk to the vindictive control freak and ask
her why she would do such an obviously cruel thing. If she had your best
interest at heart, she should have talked to you and the surgeon at the
same time...oh, it just makes me furious. I have tried for a long time to
explain to my family/friends (whatever the case may be) about the
prejudices against obese people. It is not very hard to
understand....people are bigoted for alot of different reasons...why else
would so many people be discriminated against. But, it is usually more
subtle with obesity, isn't it? I'm from the South...and, I used to say
certain women down here were "Steel Magnolias"...you see they
could cut you to the quick (that's right, zing you!) and noone else would
notice because they had said it in a soft, sweet, honey-dripping voice!
I'm sure they have the same women up North...but, I have never been there,
so I can't talk from experience. Well, listen to me ramble...and, I just
wanted to support you..but, it just made me mad for you ~ against her, and
all. Take care...and have Peace~Terri
— Terri G.
November 30, 2000
There is also something called a "self-fulfilling prophecy",
which in psychiatric circles means that sometimes your expectations lead
you to behave in such a way as to provoke or bring about the very
situations or responses you fear. While it is possible the client here
behaved in such a defensive way as to arouse the suspicion and
defensiveness of the psychologist, it is also entirely possible that the
psychologist treated a mildly suspicious patient in such a way as to make
HER much more anxious and self-protective than before. The psychologist in
this situation is the clinician with the license, and as such, has a duty
to remain objective and calm, and put her patient's feelings and concerns
before her own. Anything less is substandard care.--One who has to abide
by those standards
— [Anonymous]
November 30, 2000
It sounds like lawsuit material to me. I'm so sorry you had to deal with
that. By contrast, my psych exam through Kaiser was the most pleasant
experience of all my various tests and exams. We basically had a 45 minute
conversation. And in fact I would have enjoyed talking to her longer.
Hang in there and please do not let this deter you from having this life
changing surgery. Hugs!!!
— Paula G.
November 30, 2000
I'm so sorry to hear about your ordeal. I have been to many doctor's and
have had to deal with the discrimination, also. I wanted to tell you, my
appointment with my psychiatrist was a nice experience. I filled out a few
pages of medical questions, the normal. Then I spoke with the doctor. We
talked about 30 minutes, he was very nice. He told me what he knew about
the psychological affects of the surgery, and I told him why I wanted the
surgery. We both agreed I get the surgery! I don't know if confronting the
doctor you went to see is a good idea, she obviously has issues of her own.
What about a second opinion? I know the cost is high. I think you may
benifit from talking to this woman's supervisor, too. Good luck in your
endevors.
— janetlynne69
November 30, 2000
The surgeon I was initially seeking also required a psych.eval before being
considered for surgery. I was traveling 3.5hrs to Omaha pursuing the
BPD/DS surgery, as no one in my area performs this type. I asked if I
could have the eval done by a Dr. in my area, and was told they preferred
that one of THIER Dr's do it, because they would know what to 'look for'.
Well, I too took the 600+ question MMPI and the shorter 150+ question test.
Thankfully I didn't have to make 2 trips, as my initial consult was
scheduled for the same day with the surgeon. The pshycologist then spoke
to me for about 40 minutes, gathering some of my history and current
details (mind you, this is the FIRST time she has ever laid eyes on me). I
too never got to see the results of those tests. She wrote and mailed an
opinion of my test results to the surgeon, who in turn, sent me a very
short very impersonal letter that said, and I quote here "Based on
your phycological evaluation, I have determined that your surgery cannot be
done by me." That is ALL it basically said, and to top that off, I
got that letter on a SATURDAY, so I couldn't even follow up on it until
Monday. By Monday, I had decided to blow off Omaha and go to Minneapolis
instead (farther, but I am sure glad I did). My eval took place on
9/28/00, I got the letter on 10/7. I took it to my pcp when I went for a
minor illness to let her read it on 10/18. She asked me what their
determination was based on and I told her the MMPI and she just laughed and
roller her eyes. She knows me, and also knows that I'm a good candidate
for surgery. She asked what the results showed, and I told her I was never
given the results. She immediately had me sign a med. records release form
to have the results sent to her, and she would interpret them with me. She
minored in physcology. She thinks the whole test is phooey. Yesterday,
11/29, I called my pcp's office to see if they ever sent my results, and
was told all they got was another letter saying the the psyche eval is done
to determine eligiblity for surgery, and that she didn't need to know the
results. I couldn't believe it!!!! I immediately typed a letter stating
that I knew my legal rights pertaining to ANY and all med records that are
MINE. I then re-requested them to FAX the result in their entirety to my
pcp IMMEDIATELY, or I would pursue it further legally. I'm going to check
back on Monday to see if they've received them yet.
I will be the first to admit that I am a strong personality. I do not shy
away from crowds, I LIKE people. And NO I'm not afraid of snakes or mice
(those were some of the questions on the d#*@ test) as I was pre-vet in
college. I to, do NOT shy away from confrontations, and am by no means a
'shrinking violet'.
I DO NOT BELIEVE THAT ANYONES SURGERY SHOULD BE BASED ON A PSHYC EVAL. The
only reason any consideration should be given to pshycological intervention
is someone who has had past mental health problems.
Just my 2 cents.
Colleen W
Sigourney, IA
Dr. Henry Buchwald, Univ.of MN
BPD/DS
pre-op, Jan.15, 2001
— Colleen W.
December 1, 2000
I find this debate very interesting, as I too have wrestled with questions
about whether my obesity was a psychological or physical problem, or maybe
both. I also suffer from chronic depression and wonder the same thing
about that ailment. I had to have a psych eval before my RnY, and lucky
for me, I had a very practical psychologist who focused on my ability to
adjust to life after surgery, and just wanted to make sure my expectations
and my personal support system were prepared for the surgery. I agree that
most of us are not obese because of psychological problems, but, the fact
remains that we do not have a cure for obesity. Even if our disease is
entirely physical in cause, the treatment isn't entirely physical. We have
to work with our surgery to make it successful, and someone with serious
mental problems might actually work against the surgery and end up
endangering themselves. Don't the surgeons need to do something to try to
weed out those seriously mentally ill people? I know the system is not
perfect, and there are some crackpot psychologists out there, but I think
there is still some room for a good psych eval before weight loss surgery.
I truly look forward to the day when the physical causes of obesity can be
cured directly, and we won't have to worry about any of this debate
anymore.
— Lynn K.
December 1, 2000
Dear friends, I am so glad to have sparked this great discussion--please
keep it going! (BTW,Please excuse the use of periods in lieu of paragraph
breaks, which this program doesn't have.) ....I am not opposed to psych
evals, per se, for there are disorders which could cause a person to hurt
him/herself, and the surgery offers some extra-easy opportunities for that.
And there are people so unready to give up overeating for physiological or
emotional reasons that even if they had the surgery they would regain the
weight, or resort to alcohol or another addiction. I know of one person
who fell into that category, and she now faces life-threatening surgery to
correct the damage.. I know of another whom I would not personally
recommend the surgery, because she has Borderline Personaliy Disorder, is
self-injurious re alcohol, sexual promiscuityy, etc., and would NOT
probably be able to stop hurting herself in addictive ways......She could
end up rupturing her pouch--a quick death--or dying of electrolyte
imbalance from prolonged/repeated vomiting. These are realistic
fears.........But it should still be her choice, if she is of sane
mind--and the criteria for that should be the same as criteria for ability
to participate in a court trial.....If we can take responsibility for
driving, paying taxes, working high-responsibility jobs, and such matters,
aren't we able to weigh the risks we face and still decide for ourselves?
If not, then we need to question anyone's right to self-determination about
chemotherapy, heart surgery, cosmetic surgery,high-risk occupations,
etc....And that is too paternalistic; it's unethical.....The psychologist I
went to defended her 4-hour invasive exam by saying that such exams are
done in even more depth for transplant patients and gender re-assignment
surgery, and so hers was justified. Well, folks, transplant teams offer
life or death and it is a lottery; thus they are FORCED to play God and
must choose the best candidate strictly on his/her abilty to use the organ
and survive long-term with it.......Not deservingness, but the
psychological health to follow the post-op regimen strictly,and so have the
best chance of survival. (So the precious organ won't go to
waste.).....With gender reassignment surgery, no medical problem exists,
strictly speaking. There are also disorders which mimic gender dysphoric
disorder; thus again the surgery team is FORCED to play God because they
are making a permanent, fudamental change in the person's entire life
BECAUSE OF A PSYCHOLOGICAL--not medical--ILLNESS. (Although people with the
disorder might reasonably debate this point; I am only using it as an
example.) Thus there is no medical necessity for physical survival--and
mistakes have resulted in suicides.....The logic the psychologist was
following re WLS was the same, whether she admits it or not. This made a
(probably unconscious) liar out of her when she declared that "we're
not in the dark ages" because they were well aware of how much of the
disorder of MO is usually physiological...............My objection was not
to the requirement for a basic psychological exam, but to: Its
length and depth (remember the IQ test); Her unwillingess to allow me
to choose whether or not to have a counselor and trust myself (as the
psychologically wounded are always urged to learn to do, doubly ironic);
her uwillingess to treat me as a human being rather than use the
"cookie-cutter" approach; Her angry response to me attmepts
maintain some dignity and autonomy; the use of speculation in her report
unsupported by the tests; her probable use of her patients as unwitting
research subjects at their own expense; and MOST OF ALL, her violation
of my confidentiality by going to the surgical team without my permission,
and discussing my case--not to mention taking away my choices in the matter
entirely by asking the surgeon to turn me away. This last was clearly
unethical.....BTW,I work as a psychiatric nursing supervisor, and earned a
3.9 B.A. in psychology in a high-demand program, and am studying to be a
Nurse Practitioner in Psychology myself....Soon I will be reponsible for
the same types of decisions as she made about me. On my job I teach
classes on coping, dealing with psycho-physiological illness, anger
management, grieving, and so on. And yet she treated me as a toddler, and
one who needed spanking at that!....Speaking as a professional in a related
field, I must say she has difficulties keeping her own issues re control
and anger out of her work, and is doing damage as a result. As the other
fellow said (thank you!), this is substandard care....Unfortunately, many
people are attracted to work areas related to their own problems, and in
her case, the idea of someone eating OUT OF CONTROL TO THE POINT OF RUINING
THEIR APPEARANCES might have given her a thrilling chill of fear and a
passionate need to control it (not to mention repulsion.).......Not all
researchers are motivated by altruism; sometimes they are simply
satisfying curiosity, or meeting darker needs of their own.
........Sometimes they do good anyway. In her case, the knowledge gained by
her research is outweighed by the harm she is doing to the individuals who
are funding her research with their $800.00 exams.
— [Anonymous]
December 3, 2000
I agree, what an interesting & important discussion. I wasn't required
to have a psychological exam before surgery, which, I feel, is only
appropriate. As far as one being necessary before this surgery, I don't
think that makes sense. Sure, I can see there may be a few individuals for
whom this surgery wouldn't be appropriate, persons of very low intelligence
who might not be able to follow the necessary long term instructions,
and/or persons with very clear pathologies. I would think those rare
excetions should be clear to a trained health professional who would be
doing this surgery. Although I didn't have a psch exam, I did have a long,
thorough appointment with my potential surgeon pre-op. He asked questions
that were obviously intended to assess my mental status. I really fail to
understand why this surgery is treated so very differently from other
surgeries. One other thing I have yet to hear a satisfactory answer to is
this: If morbid obesity is psychologically caused rather than physiological
in nature, why is it that so many of us, myself included, find that after
surgery our problem is simply "gone?" By the time I began eating
again after surgery, my food cravings were gone, my ability to stick to my
diet was never any problem, my overeating days were finished! I would love
to hear an explanation of how my "emotional" problems were
"cured" by a physical procedure! I will agree, I may have had a
few emotional issues back when I was so heavy, but I believe they were the
"result" of the obesity, not the "cause" of it. I feel
so very confident, strong, healthy, empowered, capable, and accepted now.
Anyone who doesn't believe you are treated differently due to your
appearance is simply wrong. That difference in how we're treated is the
cause of many of the emotional problems of the morbidly obese. Probably no
different than those people who suffer discrimination for other reasons. I
have also been in the psych community & have training in the field. I
KNOW not all mental health providers are good, fair, or without issues
& agendas of their own. I also know that many newer psychologists
consider tests like the MMPI & other "personality
assessments" to be invalid, unreliable, & a waste of time. Guess
what my graduate professor called the MMPI: "a waste of time, but a
great billing item." He also said, "why do we continue to give
the MMPI? Because we don't have anything else that works any better."
Great, huh? This is all just my own opinion, but I'd still like to see
someone adress how a physical action (surgery) can instantly change an
emotional problem. The only exception to that I can think of is lobotomy.
Thank God that's not done much any more, but remember, the same types of
Doctors were doing a lot of those at one time. Trends do change in medicine
and in psychological thinking over time, this is one area where a change is
due and NOW!
— [Anonymous]
December 4, 2000
Just a note on the MMPI (Minnesota Multiphasic Personality Inventory) it
was normed using a group of Midwestern MALE blue-collar workers in 1947.
As of 10 years ago it had not been renormed. This results in several
interesting things. Most people with a pulse with test as being at least
slightly depressed. Men or women in "non-tradional" occupations
usually have skewed results of the masculinity/feminity scales and are
sometimes question about homosexual behaviors. It is possible to test as
clinically depressed and hyperactive in the same test. Students preparing
for the ministry often test as schizophrenic because the indicate that they
believe that they have a personal relationship with God and that God speaks
to them. I would challenge any psychologist who planned to use the MMPI a
the only assessment tool with someone that he/she had no personal knowledge
of.
— Nanette T.
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