The Psychological Impact of Medical Diagnosis, Surgery, and Recovery [Interview][Transcript]

Guests: Professors Scott and Michelle Hall

Presenter: Neal Howard

Guest Bio: Scott Hall, Professor of Counselor Education at the University of Dayton in Ohio, is co-author of Managing the Psychological Impact of Medical Trauma: A Guide for Mental Health and Health Care Professionals. As a partner at Hawthorne Integrative, LLC, a health care consulting and clinical counseling firm, he counsels adults with depression, anxiety disorders, PTSD and divorce-related concerns.

Michelle Flaum Hall, Associate Professor of Counseling at Xavier University in Ohio, is co-author of Managing the Psychological Impact of Medical Trauma.  A partner at Hawthorne Integrative, she is also a certified master trainer in TeamSTEPPS, and has received training in mindfulness-based stress reduction.

Segment overview: In today’s segment, Professors Scott and Michelle Hall are working to help doctors recognize the emotional toll of surgeries, diagnoses and trauma.  Their recent book — Managing the Psychological Impact of Medical Trauma: A Guide for Mental Health and Healthcare Professionals — is the first to describe best practices for treating medical trauma in health care settings.

Transcription – Managing the Psychological Impact of Medical Trauma

Neal Howard: Hello and welcome to Health Professional Radio, I’m your host Neal Howard for this Health Supplier Segment. Glad that you could join us today. In medicine, oftentimes, when you have a surgery done, no one talks about the aftermath mentally of your surgery, or your procedure, or your diagnosis. It’s all about the healing process as far as your wounds, the physical therapy afterwards. Our guest in studio today, Professor Scott and Michelle Hall. They’re working to help doctors recognize the emotional toll of surgeries, diagnosis, and trauma. They’ve authored a recent book entitled, ‘Managing the Psychological Impact of Medical Trauma: A Guide for Mental Health and HealthCare Professionals, is the first book to describe best practices for treating medical trauma in health care settings. Welcome to Health Professional Radio both Scott and Michelle.

Michelle Hall: Thank you so much Neal.

Scott Hall: Thank you Neal.

N: Glad that you both could join us today. Scott, you’re a professor of counselor education at the University of Dayton in Ohio and of course, co-author of the book that we just mentioned. Michelle, you are associate professor of counseling at Xavier University in Ohio. Scott, give us a little bit about why you became interested in the psychological impact of medical trauma.

S: Well Neal, psychology and clinical mental health counseling is been my focus in vocation for over 20 years. The changes on the landscape in integrative health care has really jumped up on the radar for clinical mental health. Not only in terms of how we us practitioners can be part of the multidisciplinary team but also from a personal standpoint. My wife Michelle had experienced the pretty significant traumatic childbirth. The process that she went through really put out on our radar as mental health practitioners. The kinds of gaps that a patient can experience in how the health care system in general addresses or in fact, doesn’t address the mental and emotional part of either a diagnosis, surgery or some other type of procedure. And so, Michelle’s direct experience is really well highlighted and dovetailed with the change in landscape and prompted this really the book and our researches that time.

N: Michelle, having experienced the traumatic pregnancy, that is an experience that is reserved for women. Talk about the differences and the psychological aspects say, you are diagnosed with cancer, there’s a psychological impact and you haven’t even had surgery or chemo yet. Talk about the difference in the psychological aspects of getting the diagnosis and being treated for the diagnosis.

M: I would say in getting the diagnosis and people has such varied responses. Some of their response ties into maybe their history in some way. Some people come to their medical experience with a lot of pre-existing risk factors. So for instance, a person could already be challenged with anxiety or tremendous mental stress or have a same way history. It came from me perhaps that patients, close family member thought cancers to come to cancer and perhaps they have a lot of experience with seeing the unfolding of that treatment. And then, other patients can have very different responses to receiving a diagnosis. I think the meaning making that people attached to a diagnosis, a certainly critical and certainly leads to this subjective experience of living with a disease of receiving treatments. And it certainly, we see people who’ve experience past medical traumas, certainly have a more difficult time when they’re diagnosed with a chronic illness, an illness in which they understand that there will be more medical intervention on the horizon. We really see such varied responses in patients and as varied as we are as human beings. One of the things that we talked about in our book is how we have to really honor that subjective experience of the patient. We say that if a patient experiences a diagnosis or an intervention that’s traumatic, then it is trauma and we have to treat it as such. We really pay attention to a whole host of factors that can contribute to a traumatic experience for patients. Unfortunately, the only kind of risk factor that has tended to be highlighted in the past, has been the risk factors that patients bring. In other words, if a patient experiences medical diagnosis or intervention as traumatic, then it’s because of the patient risk factors, something that they bring to be experienced rather than a really recognizing that a lot of medical treatments inherently can be traumatic and especially when we’re looking at life-threatening and life-altering kinds of medical events.

N: Absolutely. Scott, as a counselor, a professor of counseling, we’re talking about the psychological impact on the patients themselves. Oftentimes, the patient has a support group that someone has going to be involved in the aftercare after a surgery or someone who’s going to be there as support directly after a huge diagnosis. Are there any tips or is there any counseling available for the caregivers to assist the patient in this psychological journey during and after surgery and diagnosis?

S: That’s a great question Neal. The big stain now in healthcare is patients centered care yet that shouldn’t be limited just to the individual experiencing the medical intervention. As we all know, support systems are very important in someone moving forward in a positive way and so that should be on the radar, absolutely, that should be part of the next. One of the things that we’ve really try to highlight are the areas of life that can shift and change for patient when he or she experiences the diagnosis and so forth. That it’s not just about the physical well-being but it’s how things shift for them outside of treatment and these are areas in fact that support system should also be aware of as well. One of the assessments that we’ve developed highlights that is called, ‘The Secondary 7-Lifestyle Effects Screening’. It tries to zero in on how someone experiences areas in their life that are changing such as their career, their leisure, their relationships, developmental milestones. These are things not typically on the radar and so when the medical intervention stops, then a patient in his or her support system, for the most part seems to be left on their own to navigate and figure out how life unfolds. You’re right about that. It’s a whole system that needs to have attention, not just a patient unfortunately.

N: Michelle, in your opinion, why do you think that there exists this gap in the mental health care field when it comes to medicine becoming kind of a team sport with these support groups and everybody trying to be on the same page when it comes to congestive heart failure, or cancer or any of these other diseases of the body. But when it comes to conditions of the mind, why do you think this gap exist?

M: I think one of the reasons that the gap exists in terms of more mental health professionals being integrated into this treatment teams is that through a lot of the conversations that we had with physicians, and nurses and other health care providers. When we share some of these concepts and these new ideas in terms of integrating mental health, what we tend to hear from them is that, “This is a great idea in a perfect world. This would happen”. But, what seems to happen instead is that a lot of physicians and nurses are trying to kind of take this responsibility on themselves and try to meet some of the needs of patients in their own way. The challenge was that is that number one, they are already devoid of extra time in terms of all that they do, all the physicians and nurses to help patients. Number two, that their training is different. Another obstacle that I see quite a bit is in terms of configuring out the logistics of all of this. One is of course, the financial logistics of ensuring that mental health providers are able to be reimbursed then how will this work, how will this look and every organization is different in terms of how that’s going to work. But the other is, that cultures can be very different in terms of health care versus mental health. We’re still kind of trying to learn how to work together. A lot of the efforts in the U.S in terms of interprofessional education are really kind of charged with helping all of these different professions, learn how to work together, learn how to respect each other and learn how to really complement each other so that we’re meeting patients’ holistic needs. We see a lot of gaps but we also see a lot of opportunities. I’m hopeful that things are really starting to change in terms of recognizing that mental health professionals play really a vital role here and we can really do a lot to not only help patients and their families, but also help staff. When staff are really challenged with traumatic medical experiences because that happens as well, there’s a term for called ‘Second Victim’. The staff members really struggle with mental health concerns after a medical trauma as well. I think it’s going to take all of us to identify these gaps and we can fulfill them.

N: Scott, as a veteran of the United States Army and I’m a veteran myself at the Air Force, thank you so much for your service. You and your wife have written this book, ‘Managing the Psychological Impact of Medical Trauma: A Guide for Mental Health and Health Care Professionals. As a veteran, talk briefly about some of the challenges that veterans face as opposed to those of us who have either lived all our lives in the civilian world or are transitioning into the civilian world. Trauma exist in both of those arenas.

S: Yes. Thank you for your service too Neal. As you know that the veteran community has really been challenged in the number of different shifting ways over the most recent years in terms of having the best kind of quality care. Mental health has been the center of the radar of how that population has really been affected. A lot of that trauma and the reasons for that trauma has been in the combat arena. How a veteran processes the reasons for the traumatic experience as well as the aftermath is paramount. I think those of us that are in the field and have that on our radar, want to make sure that not only the civilian population that the veteran population not only addresses or not only receives the kind of care and intervention that helps them move through the trauma of what they’ve experienced but also the integrated life in ways that they can feel like they are contributing and have a sense of the identity that as part of who they are. We’re really looking at this at multiple levels, a hospital, the primary care, the specialty care with the variety of populations. And you’re right, my military background, I have that front center. It’s one of my main concerns with how this can be most helpful.

N: Where can our listeners go and get more information, get a copy of your book, ‘Managing the Psychological Impact of Medical Trauma: A Guide for Mental Health and Health Care Professionals and learn more about Hawthorne Integrative Health Care?

M: Listeners can read a little bit more about the book and purchase the book through Amazon – would be probably the easiest way to do that. Our website which is www.hawthorneintegrative.com and Scott had mentioned one of the assessment tools. We have several assessment tools that are part of the appendices of our book. These are all available on our website for download and so as PDF files. I’m encouraging especially those who are looking kind of in the front lines in clinical care to take a look at those.

N: I appreciate both you coming in and talking with us today, Scott Hall and Michelle Hall. Scott, professor of counselor education at the University of Dayton in Ohio and Michelle Hall, associate professor of counseling at Xavier University in Ohio. They’ve co-authored the book, ‘Managing the Psychological Impact of Medical Trauma: A Guide for Mental Health and Healthcare Professionals’. Thank you both for coming in today.

S: Thank you Neal.

M: Thank you so much Neal.

N: Transcripts and audio of this program are available at healthprofessionalradio.com.au and also at hpr.fm. You can subscribe to this podcast on iTunes. Listen in and download at SoundCloud.