This is the 2007 version. Click here for the 2017 chapter 14 table of contents.

Psychology in Hospitals

Psychology is relevant to anybody who works in a clinic or medical setting. That is why students in pre-medical or nursing programs often take psychology courses as part of their studies. In the United States, psychologists themselves are relatively rare on the staff of small hospitals, but they are commonly employed by large university medical centers and veteran's hospitals, where they provide services such as the following:

What are services provided by psychologists at larger medical centers?

Diagnostic testing, using standard psychological tests to assess mental disorders, level of adaptive functioning, brain damage, or other clinically-relevant characteristics

Patient interviews to determine the possible relevance of psychological factors or possible need for counseling before or after medical intervention

Staff support, talking to the physicians and making morning rounds with them

Counseling patients before surgery, chemotherapy, and radiation treatments on what emotional reactions to expect and how to deal with them

Therapy for specific disorders, such as pain, facial or muscle tics, and bedwetting

Rehabilitation counseling and training for amputees and for victims of stroke, burn, spinal cord injuries, and heart disease

Counseling overutilizers, patients who use medical services too often

Consider one of those categories: counseling overutilizers. Overutilizers are people who come to the hospital too often.

Emergency Rooms are expensive places to get treatment, and they are intended for genuine emergencies. Some people use them for conditions that could hardly be called an emergency. My wife's favorite example of this, when she worked in an Emergency Room, was a patient whose complaint was "abdominal pain for 10 months." Unless the pain had suddenly gotten worse, which it had not in this case, this patient should have gone to a regular, non-emergency medical clinic.

Who are "overutilizers" and how can counseling help?

In addition to people who come to emergency facilities with non-emergency problems, there are two other common categories of overutilizers: (1) people who request medical care but have no detectable ailment, (2) people with chronic psychiatric problems. Falling into both categories at once are people with factitious disorders (p.556) who are sometimes "addicted to the patient role" and skilled at simulating genuine illnesses.

Overutilizers respond well to brief psychological consultations. They are easily detected in the triage process, used in most Emergency Rooms, whereby incoming patients are screened to determine who really needs emergency care. Research indicates that, for people coming to a clinic with imagined disorders, even a single session with a psychiatrist or a psychotherapist reduces the number of later hospital visits.

What is the distinction between rehabilitation psychology and psychological rehabilitation?

Psychologists are involved in two different types of rehabilitation at medical centers:

1. Psychologists counsel people suffering medical disorders or facing medical treatment that requires lifestyle adjustments. This is rehabilitation psychology or rehabilitation counseling. Rehabilitation psychology is aimed at helping people adjust to the aftereffects of injury or disease.

2. Psychologists aid in the adjustment of formerly-hospitalized psychiatric patients. This is called psychological (or psychiatric) rehabilitation. Psychiatric rehabilitation is aimed at helping such people adjust to the "outside world" so they can live independently outside the hospital.

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