Question:
Before you go to the Consultation: How I avoided a psych eval

Recently there has been a few posts about the delays to surgery because of psych evals. Most problems seem to be because of biased doctors who don't understand the necessity of WLS or are clouded by erroneous and antiquated information about the subject. All those who have had this obstacle to conquer before surgery have my compassion. I am one of the few that I know of that was NOT referred for an psych eval, and I am wondering if it was simply because my insurance didn't require it, or if it was how I interviewed in the initial consultation. At the consultation with my surgeon, I was asked why I wanted to have this surgery and what three things I would do when I lose weight. All of my answers centered around health and activity level - I never mentioned anything about appearance or relationships. I do believe this was a pivotal point for me that made the eval unnecessary. Of course, by the time I went in for the consult, I was well-informed, had realistic expectations of the surgery, recovery and long-term results and comfortable with my decision. Certainly there are some people that do need to be evaluated, but there are so many of us that have gone through this process unnecessarily that I just wanted to share my experience to see if it would help anyone avoid additional expense and delays. After all, just because we are obese, doesn't mean we are emotionally or mentally challenged and can't make our own decisions! Also, I would suggest that if anyone is referred for a pysch eval, ask the WLS surgeon to recommend a WLS-friendly doc. A good surgeon should be working with someone reputable.    — Allie B. (posted on September 9, 2000)

September 9, 2000
I was so glad to see your post. I am sooooo sick and tired of seeing psychiatrists who are sicker than their patients. I have seen more than a few wacked out ones over the years, especially a few my daughter saw as specializing in pediatric psych. Why, they would have scared the you know what out of any child. Talk about not knowing how to gain a childs trust and confidence!!! I am worried about getting a diagnosis of untreated depression which would curtail my surgery. There was another post about taking a short term course of therapy (6 wks) and maybe getting around all this but I feel that the more I open my mouth the deeper in I will get. I argue that I am NOT depressed. There are some things I feel sad about, there are some things I feel angry about, sometimes I am happy and sometimes I am simply peaceful and content. When I have time I enjoy some hobbies, I enjoy my work and sometimes I even enjoy cleaning my house (not often). I look forward to many things. Basically I am happy, except for a few things. I am very clear in my mind about all this; unhappy...A. weight and related physical problems B. things are tight financially right now but that is changing. There has been no explanation as to WHY I have been given this diagnosis that makes any sense, or that I can even understand and I am far from stupid. I wonder how many others on this site are diagnosed with this and are the same as me. We are fat...face it (we have) there are many things we are not happy about, sad about and angry about...that is not depression. I do not mean to take anything away from those who truly are depressed and need medication to right their body of this disease because there are many who are helped by treatment and medication. I just feel that this is so over diagnosed. Depression seems like a convenient diagnosis for what all ails a person. I always believed a "normal" person has different emotions. The movie Armageddon comes to mind here, the physical and psychological evals: BillyBob Thornton says "but can they physically survive the trip?!" I feel that is where we are at 1. can we physically survive the surgery? 2. Do we have an understanding of what we are undertaking here and are we reasonably sane enough to deal with it successfully? The last thing we need is someone giving the insurance company some ammo to fire upon us. I never expected a house with a picket fence in life and I can live with it.
   — JennyLynn A.

September 9, 2000
Hi, My WLS surgeon didn't order a psych evaulation for me either. I went into the consultation well prepared, he said he could tel by my research and preparation that I did not need a psych evaluation. I also focused on the health benefits of weight loss surgery and my concerns for my future health. I wrote a five page outline covering many areas including current health problems, family health problems, recent medicatl tests, past diet attempts, doctor and insurance information, and most importantly I included a couple of paragraphs covering the reasons I wanted the surgery. I also demonstrated a realistic expectation of the surgery, an understanding that I would need to change my eating habits and that I was well - versed about possible complications. He said that many times it is up to his descretion (although some insurance companies require it) to determine if the psych eval was necessary and he didn't feel it was necessary for me.
   — Jennifer L.

September 9, 2000
All I can say is "Tell them what they want to hear". They are not there to give you long term help, so telling them all your problems is not in your best interest. I just basically told them I was doing this primarily for my health. Just try to be/sound as well-adjusted as you can. I did not lie about myself, I just didn't offer all the negative juicy stuff. Just my 2 cents...
   — DOROTHY A.

September 9, 2000
Before insurance companies 'invest' $20,000+ in an optional surgical procedure, they want to know it's going to work for that patient -- So the question rises: What is this patient's mind set? Stability factors? It is shown that compulsive personalities have difficulty adhering to a set program... Is this patient compulsive in behavior, etc.? In my case, I stopped my psychiatrist from writing me ANOTHER anti-depressant prescription by saying, "I have concluded that if I am depressed, it is because of my current condition and life quality. We can write another anti-depressant prescription and slap another band-aid on the problem, or we can tackle the problem head on, and I prefer to eliminate the SOURCE of my depression... this weight I carry and the way it so adversely affects my life and keeps me from LIVING and MOVING and BREATHING. I have talked to my primary care, who is very supportive of my decision to have bariatric surgery and feels that, for me, it is an excellent option." I explained to him that I exhist, I do not LIVE, and even HE would be depressed in my shoes. I told him that, yes, this is a 'drastic' procedure, but my weight is far more 'drastic' than his, and the physical symptoms I deal with every day is beyond anything he can comprehend without having lived it himself. He thought it over, reached for some letterhead and said, "You're right". LOL! He wrote out a letter of referral then and there. HA!
   — Michelle F.

September 9, 2000
My insurance requires a psych. eval. before they will approve the surgery. I was very nervous going in, but when it was over I was glad that I had gone. The psychiatrist was very nice and extremely supportive. He gave me a lot of advice on how to avoid sabotaging my success and how to deal with some of the negative feelings that I'll experience after the surgery, like mourning for the food I can't eat. I know that the Dr. I saw was probably an exception though, based on some of the things that I've heard. Whether or not you're trying to avoid having the psych. eval. though, going into your consultation prepared is definitely a good idea because then you're not trying to absorb everything and can focus on the areas that you have questions about.
   — Terry M.

September 9, 2000
Hi. At my initial consultation with my surgeon I asked him outright if he required a psych evaluation. I told him that I really wasn't sure if my insurance would cover it and if there was anyway to not have to (possibly) pay for it myself, I'd appreciate it. I was also VERY prepared with my research, medical data and as complete a diet history as I could document. He told me that since speaking with me and reviewing all the data that I had with me (including a "top ten" list of "reasons why I believe I'm overweight", (a question on the profile that he'd sent me) HE wouldn't require one UNLESS my insurance required it. Fortunately they didn't. I realize I'm one of the lucky ones, and I'm very grateful that that was ONE hoop that I didn't have to jump through. cj timko
   — cj T.

September 9, 2000
Allie, first let me tell you i asked if i needed a psych eval with Dr B at BTC/BELVIDERE.. and was told that i do not.. i asked why and he said because there were no red flags on my paperwork. So basically i would guess that you did not have any red flags either.. I will say i did not ask what the red flags were.
   — blank first name B.

November 21, 2000
I don't understand the question of psych approval. Although in the entry I read the person said that just because we are overweight doesn't mean we are mentally or emotionally challenged, I see this differently and have different experiences. From the time I was a child the weight, the compulsion to eat, the obsessional thinking about foods and quantities of foods took me over. My life was about food and the fat and the obsession made me depressed. Staying fat made being thin difficult. Situations with sexuality came up. When the psyche takes such a battering why would many of us not get upset and depressed or anxious about diets that work until we fall off. Any therapist who cannot see the link between the emotions and obesity is small minded and not well informed about eating disorders. There are those of us who don't eat that much and are obese; I believe they are in the minority. I was in an eating disorders unit of a hospital three times. I wasn't even that obese; I weight 150 pounds. I learned about connections between feelings and eating food. What I am leading to is that a weight loss, learning how to keep it off through this surgery is imperative now that we have this option. My psychiatrist knew the intensity of my pain over this "condition" of morbid obesity. She gave my doctor the green light immediately saying it would allay my depression, certainly lessen it. So, I don't think there is a reason to try to get past the shrink. Just tell the truth. Maybe I'm missing something. In fact, therapy after the surgery is important for many of us because without the food the feelings loom. A therapist helps us sort all these confusions and painful feelings out in an objective environment of trust. Again, the lives we've led in a "skinny" society that makes us feel like outcasts is a setup for depression and agony. It's only logical that one would respond this way. For what it's worth, Bea
   — bea S.

January 1, 2001
My ins. (BC/BS) requires a psych eval. I went in, answered what the doctor asked, gave no additional info, other than what he asked. Don't give more info than what they need. Keep it simple, to the point and help them to understand that this operation will greatly improve your quality of life, thus reducing stress and helping you to be a healthier person.
   — Dhelynn

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