This joint working party report which was chaired jointly by a
surgeon and liaison psychiatrist, describes the psychological
problems that can occur to a patient during a "surgical journey",
from the initial consultation in the outpatient department, through
the pre- and post-operative phases, to recovery on the ward. Later
complications of surgery are also discussed, for example coming to
terms with disfigurement. The potential psychological and
psychiatric problems that can occur at each stage are outlined,
together with suggesed lines of management. Special areas such as
psychological problems in an Intensive Care Unit and Accident and
Emergency Department are included, and there is a separate section
on psychological aspects of paediatric surgery.
Methods of providing psychological care to surgical patients
are described, and there is an important section on the ways in
which interviewing skills deployed by the surgical team can be used
to promote both the disclosure and recognition of psychological
problems in patients undergoing surgical procedures.
Many surgeons experience difficulty in referring patients for
psychiatric or psychological assessment. The timing and
appropriateness of the referral process ar discussed, and there is
an account of the mental health professionals (health
psychologists, clinical psychologists, liaison psychiatrists, nurse
therapists, etc.) with requisite expertise to manage these clinical
problems.
Surgical tutors are encouraged to incorporate the
recommendations made in this report within the fabric of both the
undergraduate and postgraduate surgical curriculum. Untreated
psychological disorders in surgical patients can lead to excess
service use and costs in general hospitals, and surgeons in
training need to have a grasp of these issues. The report ends by
suggesting ways in which the recommendations made in the report can
be implemented in clinical practice.