Sample letter to your Psychiatrist

PSYCHOLOGICAL CONSULTATION REQUEST RE: GASTRIC BYPASS

Dear Doctor:

I am requesting a psychological consultation with respect to suitability for surgical treatment of Morbid Obesity by gastric bypass.

Gastric Bypass is a major surgical operation performed by either laparotomy or laparoscopic technique, in which the capacity of the stomach is severely restricted and the foodstream is diverted into the promimal small intestine. Patients experience an early sensation of fullness followed by a sense of satiety. The operation serves as a powerful support for alteration in eating behavior and requires compliance with a simple program of maintenance to achieve optimum and sustained weight loss.

Surgical treatment is associated with a mortality risk of less than 0.5%, and morbidity of less than 10%. Typically, weight loss is dramatic and sustained and is associated with resolution of over 90% of comorbid conditions.

Please evaluate and include in your report:

1. The reason for the evaluation
2. How does the patient think the surgery will benefit him/her
3. How long has obesity been a problem
4. Sources of stress or concerns in present life
5. Personal history (lives where, home situation, family interactions, etc)
6. Medications
7. Tobacco, alcohol, recreational drug use, if ever. (How long since)
8. Family history (include physical abuse, child sexual abuse)
9. Schooling
10. Marital status (history to present)
11. Behavioral observations
12. Test results (validity indicators)
13. Impression

Please rule out the following in your report:

1. Drug use
2. Alcohol use
3. Untreated depression
4. Suicidal tendencies
5. Eating disorders
6. Compliance issues
7. Comprehension (Does the patient really understand the surgery and needed lifestyle changes?)
8. Ability to make lifestyle changes
9. Compliance in diet
10. Compliance in exercise
11. Understanding of the need for follow-up no matter how far away the patient lives
12. Reliability
13. Understanding that noncompliance puts them at risk
14. Unrealistic expectations
15. Inadequate support
16. MMPI

The results of your evaluation will assist in determining my suitability for gastric bypass surgery, and will also be made available to my insurance carrier for determination of coverage eligibility.

Thank you for your assistance.

Sincerely,

___________________ (your name)