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Ethics in Practice:
James D. Capozzi, Rosamond Rhodes, and George Gantsoudes
Ethics in Practice. Terminating the Physician-Patient Relationship
J Bone Joint Surg Am 2008; 90: 208-210 [Abstract] [Full text] [PDF]
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[Read Letter to the Editor] Dr. Capozzi et al. respond to Dr. Lack.
James D. Capozzi, M.D., Rosamond Rhodes, Ph.D., George Gantsoudes, M.D.   (23 January 2008)
[Read Letter to the Editor] A Psychologist Responds
Dorothea Z. Lack, Ph.D.   (7 January 2008)

Dr. Capozzi et al. respond to Dr. Lack. 23 January 2008
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James D. Capozzi, M.D.,
Orthopaedic Surgeon
Mount Sinai Medical Center, New York, NY,
Rosamond Rhodes, Ph.D., George Gantsoudes, M.D.

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Re: Dr. Capozzi et al. respond to Dr. Lack.

capoz5{at}aol.com James D. Capozzi, M.D., et al.

We thank Dr. Lack for her insights from a psychologist's point of view. There most likely was, in this case and in many others like it, a hidden agenda. I am sure a consultation with a psychologist would have been most helpful. I know of a work related injury treatment center that routinely has all of its patients see a psychologist because they, too, have found that in many instances, patients who delay returning to work do so not because of injury related issues but, rather, becuase of other issues such as job dissatisfaction, employer conflicts, or personal issues at home.
A Psychologist Responds 7 January 2008
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Dorothea Z. Lack, Ph.D.,
Psychologist
Independent Practice. Affiliate staff, California Pacific Medical Center, San Francisco, CA

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Re: A Psychologist Responds

dlack7{at}aol.com Dorothea Z. Lack, Ph.D.

To The Editor:

Drs. Capozzi, Rhodes and Gantsoudes describe one of the difficulties that often arise in clinical practice. The patient has what is often called in psychology "a hidden agenda." The doctor and the patient have different goals for the treatment. The doctor is devoted to treating the physical problem, the patient is focused on trying to avoid her work situation for one reason or another. This is a dilemma in which a psychologist could really help.

If the doctor were able to refer the patient for an interview or two, the probability of a positive treatment outcome would be enhanced by making the hidden agenda transparent, and helping the patient to make whatever adjustments were necessary to cope with the work situation.

Recent studies have identified a variety of psychological factors that correlate with outcome in TKA and THA(1-4). Pretreatment interventions have been identified as useful for patients who are anxious, depressed and in pain. If this patient had been interviewed pre-treatment, her vocational difficulty might have been identified. As it is, a postreatment referral might just be the answer, and help the patient to avoid losing her doctor, and to have a more positive outcome.

The author did not receive any outside funding or grants in support of her research for or preparation of this work. Neither she nor a member of her immediate family received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the author, or a member of her immediate family, is affiliated or associated.

References:

1. Smith, B.W., Zautra, A.J., The role of purpose in life in recovery From knee surgery. Int. J. Behav Med. 2004; 11(4):197-202

2. Faller, H., Kirschner, S. & Konig, A. Psychological distress predicts functional outcomes at three and twelve months after total knee arhtroplasty. General hospital psychiatry. 2003;25(5): 372-373.

3. Lingard, E.A., Riddle, D.L., Impact of Psychological Distress On Pain and Function Following Knee Arthroplasty, J Bone Joint Surg Am. 2007;89:1161-9.

4. Salmon, P., & Hall, G.M., Postoperative fatigue is a component of the emotional response to surgery: Results of a multivariate analysis. Journal of psychosomatic research. 2001;50(6):325-335.