Pre-Surgical Assessments

Why do I have to get a psychological evaluation to get my surgery?

It surprises people that several types of surgeries usually require a psychological assessment prior to approval by the surgeon and/or the insurance company. But that is not because anyone thinks that “you’re crazy.”  The assessment is required because the physician and insurance company want to know beforehand if there are factors that could negatively impact your surgery or your recovery.  With pre-surgical psychological evaluations, the primary questions are whether a patient is ready psychologically for the surgical procedure and whether there are any mental health issues that might interfere with the patient having an overall successful surgery.  

Bariatric Surgery (e.g., gastric sleeve, Roux-en-Y gastric bypass)

The popularity of weight loss surgery has increased dramatically.  But the decision to have bariatric (or weight-loss) surgery should never be taken lightly.  And there are many criteria that a bariatric surgeon and insurance company look at before considering a patient for weight loss surgery (such as obesity-related health problems and pulmonary functioning).  Because of the significant psychological and emotional implications of bariatric surgery (such as the increased risk for divorce and the transfer of addictive behaviors), it is not surprising that psychologists often play a significant role in the process (both before and after surgery). 

Although it may seem that way, a Psychologist is not trying to rule a patient out but rather is trying to determine if the patient is likely to be successful with the changes they will face and whether additional assistance and support needs to be in place before they take that big step.  For example, the psychologist and surgeon need to know whether the patient is going through significant turmoil in their personal life, if there is an emotional problem that has gone untreated that requires stabilization, and whether a patient truly comprehend the changes, risks, and requirements they will face with bariatric surgery. 

As you can guess from what you’ve already read, it is very important that this assessment be done by a mental health professional who has knowledge and experience in the area of behavioral medicine and understands and follows the recommendations from 
The American Society for Bariatric Surgery to ensure that your evaluation will be accepted by the surgeon and the insurance company.  

Important Note:  I have recently had patients tell me that there are providers (although their specific licensure is not known) who are offering to complete evaluations by telephone; please know that this is not considered an ethical or acceptable practice standard for a licensed mental health professional and would not comply with the laws and regulations related to Psychologists in most or all states in the U.S. 

The ultimate goal of the pre-surgical psychological evaluation is to help to keep you safe by identifying potential barriers and risk factors to your health and overall functioning before your surgery.

Spinal Cord Stimulator Implantation (Trial and Permanent)

Dr. McBee has extensive training and over 20 years experience, in the evaluation and treatment of chronic pain and one of the more recent treatments for some types of chronic pain is a Spinal Cord Stimulator (or SCS).  This electrical nerve stimulation device has a small pulse generator that sends electrical pulses to nerves in the spinal cord that are believed to contribute to or cause some types of chronic pain to disrupt (or confuse) the nerve transmissions that cause you to feel pain.  But because not everyone does experience relief, your surgeon will first insert a temporary electrode to the affected area in your spine to see if this device will be beneficial in relieving your pain distress and improving your physical functioning. 

Prior to the trial device being tested on a patient, they are referred for a psychological evaluation. In the same way some surgeries require a cardiac stress test to make sure that your heart can handle the surgery, the psychological assessment is scheduled to rule out the the possibility that a life, cognitive, or emotional issue is likely to cause you to have a negative surgical outcome and/or recovery.  Just one example is that a patient whose memory has become impaired may have great difficulty remembering how to operate the SCS in a safe manner.  The psychologist is not your enemy in your search for help with your ongoing pain, but can be a very valuable resource to help you learn to cope with (and hopefully diminish) your chronic pain.

Usually you will be seen for two appointments – the first appointment is for the assessment itself and the second appointment is to receive feedback regarding the results of the assessment.  Although patients are not required to schedule an appointment for feedback, it is strongly recommended since HIPPA laws keep the physician/surgeon from directly sharing the psychologist’s report with the patient.

Here is what you can expect:

  • A discussion with a psychologist about your history and or relevant issues (e.g., the history of your illness or condition) that takes about 1 hour.

  • 1-2 hours of psychological testing.

  • 1-2 days to scoring and process the test results.

  • 1-2 days to analyze and synthesize the results and write the final psychological report.

  • The psychological assessment report is faxed to your surgeon’s office.

  • A  30-45 minute feedback session about your evaluation results (this is optional, but recommended).

The total time until your evaluation is completed is usually less than 1 week.

Note for Bariatric Patients – Following an evaluation, bariatric surgery patients have the opportunity to participate in pre- or post-surgical psychotherapy.  Dr. McBee can assist you in keeping the weight off after surgery, support you during the long road through a myriad of positive and negative life changes that can occur after surgery, and help you to overcome challenges that may prevent you from having weight loss surgery.

Obstacles in the path are not obstacles, they are the path.

Zen Proverb 

In March 2020, I moved my practice from my Carrollton office to a telehealth practice (a virtual office where services are provided by video conference) to minimize the risk of coronavirus transmission to my patients.   With ongoing health concerns for many in our population, I have decided to continue to provide all telehealth services through a secure, HIPAA-compliant portal and do not know if or when I will return to my office-based practice.  Please note that I am accepting new spinal cord simulator and bariatric pre-surgical evaluation patients; I am also happy to take new psychotherapy patients as the schedule permits.  Please email me from my contact page if you are interested in any of these services.  And stay well.