So, What does a Medical/Health Psychologist DO? Blog #4

My day usually starts at about 7:30 AM and I try to be home by about 6:30 PM or sooner. The older I get, the longer these days feel! I see about 9 patients per day, write reports and notes, call physicians and call back patients who have called in, deal with insurance companies (although I have an excellent Administrative Assistant who does most of that; she also schedules patients and collects co-pays). I also go through the mail, encode payments from insurance companies on an excel spread sheet, pay the bills associated with having a practice, and occasionally talk to colleagues. Sometimes, I visit hospitalized patients or patients in hospice.
As I noted in my first blog, my basic agenda is to enable a person with chronic pain or a chronic health condition to have an improved quality of life. For example,this may involve teaching basic anatomy about the back and back pain, how sciatica or other pain can develop from a nerve that is being impacted, how scar tissue can cause pain, how pain and stress impact on serotonin levels leading to depression, among other things. I use models and charts as aids in this regard. Physicians generally do not have the time to explain such basics but I think it is important for people to understand as much as possible about their pain and/or their condition. This can dispel some of the fear and anxiety that develops as a result of pain and physical dysfunction. Sleep is almost always an issue and I may discuss sleep basics and something called sleep hygiene to help improve sleep. I stress the importance of pacing and modification of activities in order to re-engage in missed activities in some form again. Managing pain and chronic health conditions frequently involves problem-solving and I address this on a regular basis so that my patients can eventually learn to problem-solve on their own. Effectively communicating with health care providers is taught because such communication is essential in healthcare. Providers often talk over their patients' heads and patients often do not go to the appointments prepared with written questions that need to be asked. Communication with family and friends can be adversely affected when someone does not feel well and this can lead to alienation and isolation which only makes someone feel worse and impair family functioning.

I use a philosophical approach that is referred to as a biopsychosocial model of illness and pain which most medical psychologists endorse. This involves the interaction of biology, psychology, and social factors that impact on an individual and their health. For example, if someone is improving physically, but is living with an abusive alcoholic, that social aspect of their situation will impede recovery and has to be addressed. In terms of therapy, I utilize cognitive-behavioral therapy also known as CBT, this is an approach favored by most pain and health psychologists. Basically, negative beliefs and how we think and appraise or judge situations are going to impact on how we feel and how we behave. For example, if we tell ourselves that we are never going to get better or our pain will never improve, this will lead to feeling hopeless and depressed with a lack of motivation to do those things that have been suggested to aid in recovery or improvement. Learning to think accurately is critically important and my patients probably get tired of my incessantly asking them if what they are telling themselves is fact-based or emotion-based and inaccurate. The facts are almost never as bad as what we tell ourselves about a situation.
In CBT, it is also important to identify automatic thoughts or inaccurate, emotion-based beliefs that develop prior to adolescence. These are such thoughts as "I am not good enough unless I do everything perfectly". Of coures, this is inaccurate and emotion-based and not based on facts and will only lead to feeling depressed, anxious and worthless. Such over-learned beliefs are identified and challenged with facts. This has to be done consistently since these kinds of beliefs can be difficult to effectively change.

I also do evaluations for Spinal Cord Stimulators and Intrathecal Pumps. These are physically implanted devices to aid in managing pain. The first involves a small generator implanted in the upper buttock (usually) with leads attached to wires placed under the spine and as close as possible to the spinal cord. In order to feel pain, the signals have to register in the brain and a SCS serves to block some of those incoming pain signals, thus providing pain relief. An intrathecal pump is a larger device that is also implanted that contains narcotic or opioid medication that is sent more directly to the spinal area and typically requires less medication than narcotics taken by mouth. Pumps also have less impact on brain functioning and fogginess that can be problematic with narcotics.