You fix your feet;
why not fix your feelings?
By Susan H. McDaniel, PhD • APA President
At the University of Rochester, our department of orthopedics is conducting
universal screening for anxiety and depression. Seriously. I had firsthand
experience with this myself after foot surgery last year. Then as now, the
ortho department uses small iPads to administer personalized brief versions
of PROMIS (Patient-Reported Outcomes Measurement Information System)
to screen for mental health issues with each visit. The results
are automatically sent in graph form to my electronic health
record so my orthopedist, Judy, can show me the results on
her computer screen. My surgery involved this otherwise-nice
woman shortening a few of my toes (ouch!) and a few other
unspeakable things that affected my PROMIS scores. Not
unexpectedly, but nevertheless, there it was.
How is it to receive comprehensive, integrated care from
your surgeon? Pretty good, I’d say. My negative PROMIS
scores decreased and my positive scores increased as I got rid
of the cast in the spring, went to physical therapy and began to
exercise again. All good news for me.
Later, I asked Judy why the department invested all this
money in PROMIS, along with a consultant who immediately
connects any patient with problems to community mental
health. Most orthopedists would agree that their specialty,
by tradition, cares about your bones, your outcomes and
their success — in short, they care about your feet, not your
feelings. But she said what we all know: That orthopedists
now understand that their patients’ outcomes are affected by
their mental health status (their ability to exercise, tolerate
pain, readiness for surgery, recovery time, etc.). These
physicians now see that their work can depend on our work.
Health care is changing so rapidly around us that it
is hard to keep up. There are opportunities like this to
study, consult, evaluate, treat, coach and administrate in
places that traditionally have been closed to psychologists.
I recently observed a female resident being precepted by a
different female orthopedic surgeon. 1 The preceptor was
concerned that this exceptionally bright young resident was
getting a reputation for being arrogant. (In the handful of
years that I’ve been coaching physicians, no one has ever
mentioned this as a problem with male surgery residents,
but we’ll leave that alone for now.) The physician faculty
communication coaching program developed because of the
dean’s concern that our medical center would lose money
with reimbursement is partially tied to patient satisfaction.
However, faculty and leaders quickly saw coaching as filling a
big void of need related to relationships, communication and
leadership skills. (As I write this, I’m scheduled to observe a
finance meeting next week.)
I mention communication coaching because it is only
one of the many ways that some in health care are ready and
willing to make psychology and psychologists an integral part
of the system. We see it in how questions in the social sciences
have increased dramatically on the MCAT medical school
entrance exam. We see it in the response I invariably get when a
department hires one of our young, talented psychologists: “We
want more of her time!”
For those clinicians, researchers and consultants who want
to work in health care, we need to ask ourselves: How can we
train our students so they are ready for these opportunities?
How do we teach them to build relationships and manage
uncertainty? And how do we prepare teams so they can fix our
feelings as well as our feet? n
1 Another interesting detail: whereas our general surgery department now has 50 percent women
in the residency, orthopedics only has 11 percent. It used to be thought that you need to be
strong to saw on limbs but those days are long gone. The gender gap is still alive in orthopedics.
These physicians now
see that their work can
depend on our work.