In his presidential address of 1994, former American Psychological Association President Jack Wiggins spelled out what he believed would be the future of psychology (Wiggins, 1994). Dr. Wiggins pointed out that in the past, the professional fields of psychology and medicine were often conducted more or less independently of each other. He believed that in the future, this must necessarily change.
Dr. Wiggins noted that the leading three causes of death at present are heart disease, cancer, and cerebrovascular disease. He pointed out that all of these diseases can be very difficult to treat. In capitated medical systems, where greater emphasis is being placed on prevention, the primary means of preventing all of these conditions are behavioral.
For example, suppose a patient is diagnosed as being at high risk for heart disease. A physician might recommend that the patient do the following:
The doctor might then wish for the patient to come back in a couple of months to discuss how well the changes are going. The above scenario, unfortunately, is all too common in our medical system. It is one that many patients have experienced and have found to be totally overwhelming. They find themselves unable to make the necessary changes, or often even understand what they should do or what they should be eating. Nevertheless, this. Prevention of these sorts of disorders often requires a great deal of behavioral change, and this is the domain of the behavioral sciences.
It was Dr. Wiggins' contention that in the attempt to effectively address the concerns involved in the prevention of the leading causes of death, implementing a behavioral change technology will be of paramount of importance. He felt that of necessity, this will bring the professions of psychology and medicine closer together.
The current cost of health care in the United States averages about 1.3 trillion dollars per year, and for a long time these costs have been growing faster than inflation. As managed care attempts to bring these spiraling costs under control, one of the most important areas to address are behavioral factors. There is a large body of literature which states that behavioral factors can give rise to increased risk for the onset of medical disorders, increased seeking of medical care, and interfere with compliance and otherwise to delay recovery.
Given the severity of the problem, it is not surprising that national organizations such as the North American Spine Society recommend psychological assessment to detect such problems early on, and to use appropriate psychological treatment as necessary to address any psychosocial barriers to recovery.
When performing psychological evaluations for Worker's Compensation or Personal Injury cases, a number of questions are commonly raised. Evaluators are commonly asked to form opinions about the following:
In some areas of the practice of health psychology and rehabilitation, there is a good deal of litigation. This only serves to increases the pressure present in the evaluation. In any case however, it is important to perform an evaluation that is as neutral and objective as possible. As an umpire, you do not play for anyone's team. Sometimes you will be accused of working for the Dodgers, and other times you will be accused of working for the Yankees. It is a good rule of thumb to remember that as a treating professional, you must to some extent be an advocate for your patient, and work out of that alliance. As an evaluator, though, taking sides or entering an evaluation with an agenda is not fair.
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