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?
1Another 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.