The cow ran away with the spoon


Situation 1:

A patient sees his or her physician with complaints of chest pain and job stress. The goal is to ascertain psychosocial and physical processes that may cause the chief complaint, chest pain. The physician asks for a history of recent life stressors and behaviors and wants a consultation with a psychologist. Based on a combination of psychological factors and standard lab tests, the physician forms a diagnosis but does not want to meet with the patient until he, the patient, has seen the psychologist. However, this 45-year-old gentleman does not agree to see the psychologist and will not listen to reason as to why this is recommended.

As a trained health psychologist, what do you advise the physician?

Situation 2:

A physician refers a hospitalized patient to you for consultation. The patient is terminally ill, with at best a month to live. He is in considerable pain and on morphine, which makes him sleep most of the time. When awake, he is still suffering. He is completely bedridden, needing assistance even to turn over. He has dialysis treatments three times a week. The patient has said he wants all life-saving procedures possible, but the doctor and the patient’s family feel he has suffered enough and would like to remove him from dialysis. You agree that this would be a reasonable and ethical course of action. The doctor explained to you, the health psychologist, that if the patient has no more dialysis treatments, he will fall asleep and die peacefully in a day or two. The lack of dialysis will not lead to more pain or discomfort than he is already experiencing. You are asked to evaluate the patient for competency to make his own decisions. The physician does not believe he can really understand his situation and wants you to talk the patient into stopping dialysis. You interview the patient and find that he has a clear understanding of his condition, his impending death, and the implications of stopping dialysis. In spite of all this, he wants all measures to sustain life continued.

As a trained health psychologist, what is your responsibility in talking with the family and physician?