Think Like A Psychiatrist-40 Cases, Leslie Lund and Nancy Nadolski; Foothills Foundation, Boise, Idaho; 2005, ISBN 13, 0-9763885-1-0
As plastic surgery nurses, we sometimes encounter situations where a little psychiatric background and knowledge would be helpful. As an RN working in a hospital, our first contact with the patient is the day of surgery, and it is a little too late for any psychological intervention, as decisions have been made and procedures paid for. At this point, a little psychological knowledge will help us better care for the patient by providing us some understanding of the patient's motivation for wanting the surgery. As the patient searches for answers to his or her physical problems and deals with the associated personal baggage, we can calm his or her fears. Working in an office setting, the RN is often the first professional to encounter the patient. At this time, the RN's assessment and knowledge of psychological issues may set off "red flags." It becomes the RN's responsibility to alert the physician that maybe this patient is not the best candidate for plastic surgery.
Think Like A Psychiatrist-40 Cases, by Leslie Lundt, MD, and Nancy Nadolski, FNP, although of little direct value to a practicing plastic surgery nurse, is a good reference. The book is divided into sections of the various disorders and highlights each disorder with case studies. The disorders represented include: anxiety, attention, cognitive, eating, mood, psychotic, sleep, and substance abuse. Each case study gives a brief case history followed by the question, "What do you do?" The authors then discuss the various treatment options available, what their choice would be, and the risks involved. Each chapter includes a list of resources including Web sites and literature.
In truth, as a plastic surgery nurse, the chances of encountering any patients with the specific disorders outlined are slim. As we all know, most of the psychiatric-related disorders we see involve body distortion perceptions and there is a fine line between the obsessed patients and those who simply start out fixing one thing and then after that is corrected, see something else wrong. Case in point, the patient who has breast reduction surgery for issues that include persistent back and shoulder pain and often afterwards suddenly notices a big belly, which was previously hidden by big breasts. Now the solution to this dilemma is having an abdominoplasty. With the exception of the one case study in the book involving anorexia, the other disorders would probably be coincidental personality traits to what we normally see in a plastic surgery practice. Many of these patients may be under treatment for these disorders-on medication and under control. In helping us to understand the possible treatment modalities, the book has many helpful charts and tables that outline medications, doses, duration, and generic availability. These charts are beneficial in educating the nurse on medications and their actions. By the patient listing these as medications on his or her health and physical forms, they may be the initial "red flag" that there are other issues being addressed with this patient. In addition, if these patients do undergo plastic surgery, it is important to note that many of these medications cannot be stopped without some serious side effects, so drug treatment must continue to maintain therapeutic levels.
As far as the value of this book to plastic surgery practices, it is a good reference, but not nearly as comprehensive as we need in dealing with our patient base. It alone will not have all the answers, but then, again, no one source has enough coverage for all the personalities that we encounter in the field of plastic surgery.
Margo M. Bloomberg RN, AEMT/IC
Clinical Nurse II, William Beaumont Hospital, Royal Oak, Michigan