Health and Psychology

A medical psychologist is a psychologist that has post-doctoral training in the field of medicine to be able to work in consultation with a physician on the treatment of illnesses. While psychologists in California cannot prescribe medicines, most medical psychologists understand how medications work and can explain them to patients. A health psychologist has specialty training at a post-doctoral level to work with promoting health. The field of health and medical psychology works with patients that are undiagnosed, or have chronic, serious or terminal illness or psychological problems as a result of a medical condition. We can differentially diagnose psychological or psychiatric conditions from medical conditions. We can help people get accommodations for illnesses that impact functioning at work or at school. We can help people find resources such as services for the disabled or help to document functional impairment for agencies like Social Security.

An average medical appointment with a physician or nurse practitioner lasts less than 15 minutes. An average appointment with a health or medical psychologist lasts 50 minutes. That amount of time allows for more information to be provided to the patient. Medical psychologists also work with complementary medical providers such as acupuncturists, chiropractors, nutritionists, and others. Treatment is often quite brief and focuses on quick improvement in functioning or improved coping skills.

Many medical conditions cause difficulties with psychological functioning. Infection, hypertension, or a mild concussion can cause depression or anxiety that will not respond to typical psychological treatments. A number of medical conditions will mimic bipolar disorder, attention or memory problems. Psychological testing can help document how much of the symptoms are caused by psychological issues and how much is more medical in nature. It can also clarify for physicians how to communicate more effectively. Treatment can assist with desired lifestyle changes, and improved compliance with medication and treatment. In some cases it can save lives.

Jonathan was considering treatment options for occasional episodes of chest pain. It wasn’t bothering him much. He sought out cardiologists and had one tell him he didn’t likely have anything serious, one tell him that changing medication should be sufficient, and one suggested an angiogram to look at his arteries. I reviewed his history with him and suggested the angiogram. One of the arteries to his heart was 98% blocked and was opened during the procedure lessening his risk of a heart attack. I also reviewed with him how he was taking his blood pressure medications and explained how those medications worked so he would understand them better.

Sarah was exhausted all the time and kept gaining weight even though she was eating very little.  She was confused and was starting to have thoughts of suicide.  Although she had a complete physical and was assured that "everything was fine" she kept feeling faint and her hands would swell with exercise.  I saw Sarah after she attempted suicide.  Her doctor told her she had "stress."  I referred her to a specialty endocrinologist who diagnosed an autoimmune thyroid disorder and the beginnings of thyroid cancer.  The cancer was caught early, and she was treated.  Her weight dropped and her chronic fatigue lifted.

Many medical conditions are incorrectly diagnosed and therefore inadequately treated.  Most physicians don't have the time to go over a full and complete history of symptoms and many patients are not good with providing symptom data to help with differential diagnosis.  Medical psychologists can help to differentially diagnose and can work with the physicians and patients to improve communication and treatment adherence.