Health and Psychology

My students learned something important about how difficult medical diagnosis is.  They had a neuropsychological case to write up and put into electronic health records.  I then gave them each a simple complete blood count (CBC) to add to the chart.  Since each sheet had values for normal the task for the students was to review the history and neuropsychological findings and review potential diagnoses for their client.  There were three sets of labs.  One showed anemia, one neutopenia, and one leukocytosis.  The students eventually determined that the labs just showed symptoms.  Symptoms.  Not a diagnosis.

It was just like the neuropsychological testing.  It shows numbers and scores.  There's not an automatic diagnosis.  One of the cases presented data from an outdated test and used percentile ranks instead of standard scores to obscure the findings.  Another case had history provided by a parent on behalf of a young child.  The parent either had forgotten the information or simply made things up to appease the examiner.  The parent reported the child standing before they could sit and talking in sentences before they could speak single words.  "This is just all wrong.  I can't do anything with this."  The student complained.  Another case had too much information, all carefully noted.  "How am I supposed to know what's important in all this?"  the student asked.

Welcome to the real world.  In neuropsychology and in psychology we start with a history.  The history may be vague, limited, incomplete or over-inclusive.  Medical tests, records, scans and images add data that may or may not be helpful or relevant.  Neuropsychology and psychology add test data to the mix.  Medical and psychological problems may impact how well someone does on testing, including on measures of effort and inconsistency in reporting.  Treatment then changes from managing a diagnosis to documenting responses to intervention.  People become unique rather than part of a set of others with a specific diagnosis.  Treatments get tailored to the person.

Medical psychology works to empower people to design their own treatment plan and diagnostic test batteries.  That's a different way to evaluate people.  Someone asks a question.  "What do I need to do to perform better on tests?"  Medicine and some forms of psychology will ask "What's wrong?"  The answer to that question will lead to a diagnosis and a treatment plan.  Some neuropsychologists, learning disorder specialists, or psychologists will ask "What kind of tests?, What's worked before?, What helps?  What makes it worse?"  They may decide to test specific factors to see if they can replicate the problems and design an intervention.

Medical psychologists, specialists in cognitive science and the new field of neuroplasticity, and some health psychologists will ask about things that may seem unrelated as they run down decision trees.  "Can you watch a video game and pay attention, but can't remember all the steps to what your mom asked?"  Or "Are there differences in severity of your symptoms at different times of day, or with different activities?"    They help patients make logs and records to capture data.  They help them partner with physicians and other treating providers to change the environment for optimal performance.  It's a complex process.  I'm not sure how most neuropsychologists do neuropsychology without knowing some amount of medicine. 

For my students getting a simple CBC, changed the meaning of all the neuropsychological data they had.  In some cases substantially.  So as they move to electronic health records will that help them or make diagnosis more complicated?  It certainly helps them look things up on the internet.  But it makes it easier to overlook things.  The average physician spends about 15 minutes for a visit.  The average psychologist spends 40 to 50 minutes a visit.  Health psychologists and medical psychologists may spend several hours at an introductory meeting on an unusual case.  The purpose of spending that time is to ensure things aren't as likely to be overlooked.  I can then assist a physician with filling in gaps in history, in symptoms, in treatments and work with them toward a diagnosis and an effective treatment plan involving the patient.