On Tuesday, 1/30/2024 I had my first psychiatric evaluation appointment. It was 100% virtual, and was with a Licensed Clinical Social Worker that regularly works with the surgeon that I am going to.
So let’s answer some of the questions first.
- Yes, I already have a therapist and psychiatrist. However, neither of them are bariatric certified, and that was a requirement.
- This is most likely not long term talk therapy. This is just to see if I am capable of being successful during and after surgery
- It is not a one and done type of appointment. It usually takes 2-3 appointments to be cleared.
Creating an appointment
This was super easy. Kaitlyn, my PA that I am seeing for Nutrition, sent over a referral to the practice that they work with. The next day I received a phone call from the therapist who set me up with an appointment for 2 weeks from then. The things she asked in that phone call was mostly my name, e-mail, phone number, and what insurance I had.
The First Appointment
Stupidly, I did not read all the instructions, so I did not realize that there were forms I needed to fill out first. So when I got into the online portal, the first thing she told me was to leave the session and go fill out those forms. Here are the forms I was required to fill out:
- AUDIT: Alcohol Use Disorders Identification Test
- Client Information Form
- Client Insurance Form
- Consent for Services
- EAT-26: Eating Attitudes Test
- Notice of Privacy Practices
- PHQ-9: Patient Health Questionnaire-9
- Release of Information
Most of these are standard medical type intake forms, but I will go through each one by one.
AUDIT: Alcohol Use Disorders Identification Test
This is a form that I have not ever filled out before in this way. The point of this form is to screen for excessive drinking and alcohol use disorders. It asks how much alcohol you have had within a certain period of time, how often you black out, if you or someone you know has ever been injured from drinking, etc. I am not sure if this test is standard for her practice or required to be completed before surgery.
You can find more information about this test here: https://auditscreen.org/
Client Information Form
This form is mainly just personal information. Name, address, e-mail, phone number, emergency contact, etc.
Client Insurance Form
This form was just my insurance information. They did need a photo of my insurance card, which probably was the most time consuming part since it was online and I needed to e-mail the photo to myself. Basically they need to know the plan number, group number, etc., as well as who is the primary holder of the insurance and their information.
Consent for Services
This is another standard form that literally just says that I consent to be seen by this therapist, and that they can bill my insurance
EAT-26: Eating Attitudes Test
The EAT-26 test is the most widely used test to screen for eating disorders (anorexia, bulimia, binge eating, etc.). It asks about your feelings surrounding weight, but also if you have binged or purged recently, your exercise habits, etc. It is ESSENTIAL that you answer honestly, or you can have serious issues post surgery. I expect that this test is used because I am there for bariatric clearance, and do not expect that this is a regularly used test in her practice.
You can take the EAT-26 (or it’s predecessor, the EAT-40) here: https://www.eat-26.com/
Notice of Privacy Practices
This form is a standard form used in medical practices that informs the patient about privacy practices within the medical practice. Basically this says that they will not share my information with anybody unless I give prior written authorization.
PHQ-6: Patient Health Questionnaire-6
You would think that this form asks about your entire medical history, however it is really a questionnaire to check for depression. It asks questions like, “In the past 2 weeks, how often have you been feeling bad about yourself — or that you are a failure or have let yourself or your family down?” When completed, the questionnaire is scored based on your responses. It is important that you answer this honestly.
Release of Information
This form is a standard form used in medical practices that allows one medical professional to share your medical information with another medical professional. If I did not fill out this form, the therapist would not be able to share her findings with Dr. Shetty, and I would not be able to get approved for surgery.
The Appointment
Once I completed these forms, I went back into the virtual meeting. From there, she asked me a number of questions. Most of these questions were rehashing things that I filled out in the paperwork-things like, “who do you live with”. She also asked about support during and after recovery from surgery, what my timeline looked like for surgery, how many more appointments I have, and when they will be scheduled for. She also asked if I knew anybody else who had had the same surgery as me
She asked about why I wanted to get surgery and what kind of support I was looking for. I explained to her that I have a therapist that I have been seeing bi-weekly to help me address my relationship with food prior to surgery. She then asked if I knew anybody else who had the surgery. I told her that I had 2 friends (both of whom had bypass rather than VSG) who were not as successful as they would have liked due to the fact that they still had some of the same eating habits. This is why I am taking 10 months rather than the typical 3 months. I wanted to be mentally and emotionally prepared for surgery, not just physically ready.
She talked a little bit about eating habits, asking if I meal planned or meal prepped (they are not the same thing). I told her we definitely meal planned, and I often meal prep lunch for most of the week. She asked if I ever skipped meals, and other questions about my eating habits.
Since we were running out of time, the last thing she asked me was what I wanted to get out of our meetings. I basically told her that since I’m seeing both my therapist and nutritionist regularly, I really just need psych clearance from her. I don’t see the need to continue with ANOTHER doctor that is doing a similar thing to what I’m already doing. She seemed OK with this, and told me that our next appointment will probably be our last.
The last thing that she did was sent me to a site with a bunch of questions about what I do when I feel certain ways, and told me to answer them before our next meeting. These were things like-what do you do when you feel bored? What do you do when you feel angry. I don’t 100% know what the point was, but I expect it’s to make sure that I have coping mechanisms outside of eating, since that option will be gone.
My Thoughts
To be perfectly honest, I don’t know if my experience is the normal or not, so please take this with a grain of salt.
I felt that this meeting was extremely transactional. She asked a question, I answered it, she asked another question. I don’t feel like she could possibly have any idea of if I could be successful or not-and honestly, I’m not sure if that was her goal.
If I wanted to take a stab at what the goal of the psych evaluation is, I would say that the goal is to make sure you are mentally sound before you make a major, life altering medical choice. If I was severely depressed, had some sort of eating disorder, etc., I would not be a good candidate for surgery since this change could have more detriment to my health than benefit. I will say that I was honest with her about my diagnosis of Generalized Anxiety Disorder and Depression, but I was clear that I have been adequately medicated for a long time, and that both conditions are well managed (with that little blip of PPD after baby was born). I do not foresee that being an issue.
So all in all, I thought it was an OK session. I wish that the whole thing was less transactional, but I do have to remember that I have other health professionals that are more hands on-I don’t need this one to be. As for future appointments, I continue my bi-weekly therapy sessions this Friday, I tentatively have my last Psych appointment on Tuesday the 13th, and I have my next nutrition appointment on the 23rd. At that appointment, I want to schedule my endoscopy, since I want to schedule that on a day that somebody can be with me.
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Vanishing Velez 
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