Reference no: EM133661601

Assignment:

Imagine being some Clinical Psychologist with most of training in the area of Health Psychology and that the private practice is located (embedded) in some multi-physician suite of offices that houses both Neurology and Family Medicine Practice group. Being on good terms with the physicians from both practices and the majority of physician referrals come from these practice groups. Over the ten years, have been practicing in this setting, and developed special experience and expertise working with chronic pain patients. Being widely recognized in the local medical and mental health communities as the "go to" person for cases where patients have on-going chronic pain complaints that have extended beyond the expected recovery time.

The patient today is the first referral from the newest member of the Neurology practice in the building. Being met with the young Neurologist and hitting it off well with her, finding her to be bright and apparently very well trained. She is of Egyptian heritage and has completed all of her medical training here in the US and her English is quite strong, though fairly-heavily accented.

The patient is 32-year old Hispanic female who is employed custodian for some rural elementary school in the small community about 20 miles out of town. She injured her lower back in work-related accident 2 months ago when she and another female custodian were emptying several large trash cans filled with unneeded papers, binders, and old editions of textbooks. The trash cans were apparently over-filled and quite heavy and the two women had been lifting them together about 3-4 feet off the ground in order to empty them into the school dumpster. Afterwards, the patient reported feeling some discomfort during the rest of her shift that evening and increasing lower back pain overnight. She added that she had substantial difficulty dressing, tying her shoes, and getting in and out of her car the next morning. She also noted that despite taking several over-the-counter anti-inflammatory pills throughout the day, she had not felt better and had been forced to call in sick (injured) to work. At that point, her supervisor put her on leave pending a physician exam and had her file a Worker's Compensation report.

The physician who evaluated her diagnosed her with muscular distress associated with a mild disc misalignment and prescribed 2 weeks of bed rest, followed by 4 weeks of physical therapy. Things had gone fairly well through the 6-week recovery period, although there had been several occasions when twisting, getting up from bed or sitting, or bending over seemed to aggravate things and caused her some setback for some day or two.

At the end of the 6 weeks, she had returned to work, expecting to be restricted to light duty tasks. However, her supervisor denied any such stipulation on her medical-release form, ordering her return to work. For the last two weeks she has been trying to work at her job at full duty, but has had several "bad days" and only intermittently has she been able to complete the 8-hour shift. In response to her continued complaints that something was wrong with her back, the Worker's Compensation insurance company sent her to see the referring neurologist who ordered the MRI of her lower back and reported that she found no significant, remaining pathology. The patient reports that when she met with the Neurologist yesterday to receive the results, the doctor told her she should be getting over it soon because there was no evidence anything was still injured.

The Neurologist's notes from that office visit indicate that she prescribed stronger muscle-relaxant and cleared her for full return to work. Apparently, at that point the patient became hysterical, crying, and alternately threatening to hurt herself and or "fire" the Neurologist from her WC case. At that point, your office received a call for the emergency consultation ASAP, leading to the current appointment with the patient. Listening to the voice message from the young neurologist apologizing for how upset the patient had become and asking for help, also stating "let me know if there's anything [she] could do.".

Post:

1. What is going to be the primary emphasis of the first verbal response to the patient once she finishes telling about these events? How can someone communicate they are listening and care about her nonverbally, even before she finishes the retelling?
2. What strategies or intervention techniques from Chapter may be helpful to either 1) reduce the intensity of her pain-experience, 2) increase her ability to tolerate being in pain, and 3) remain functional at work and home despite being in fairly constant pain?
3. How does working in what is essentially integrated healthcare setting make things better and worse for someone as the Clinical Psychologist coming onto the case?
4. What support, encouragement, and/or advice would be offered to the patient's spouse and mother who have accompanied her to the visit and have asked to speak to the clinical psychologist with her permission?
5. How would someone assess the state of the patient-physician relationship and what might someone say to each of them to facilitate improvement in their relationship?

References:

Straub, R. O. (2022). Health Psychology (7th ed.). Macmillan Higher Education.

The Role of Health Psychology in Seeking and Obtaining Health Care, (pp. 400-427)

Managing Pain, (pp. 428-457)