Personality Assessment and Health Care Reform
November 7, 2012
When most people think of health care reform, they think in terms of insurance mandates, cost-containment strategies, or even "death panels." Rarely does psychological assessment enter the discussion. Yet, it is clear from the scientific literature that psychological assessment in general, and personality assessment in particular, has much to contribute to reforming our bloated healthcare system.
As we have discussed earlier, personality assessment should be a vital aspect of psychological and psychiatric treatment. Not only can assessment be a therapeutic modality in its own right (Therapeutic Assessment), but it can contribute to accurate psychiatric diagnosis, and thus more effectively targeted treatment decisions. Take, for example, the case of a patient presenting with mild psychotic symptoms. These could reflect an underlying schizophrenic disorder, the early phase of a manic episode in a bipolar disorder, or perhaps the onset of a major depressive disorder with psychotic features. Often times it is difficult to disentangle these possibilities from interviews alone. Without an accurate diagnosis, the only recourse a treating psychiatrist has is "trial and error." This can lead to multiple different medications being tried. Not only are these medication trials expensive in their own right, but they can cause significant delays in effective treatment. The literature is clear that the earlier an effective treatment is begun, the greater the chance of success. If a competent assessment is done, however, it may be possible to establish the correct diagnosis initially, and thus select the best treatment approach the first time.
Most interesting, however, is the role that assessment may play in the delivery of non-psychiatric medical care. It is well known that psychological factors play a crucial role in disease and identifying these factors (e.g., stress) and directing treatment at reducing them can go a long way toward improving overall treatment outcome. In addition, psychological interventions are often important in improving compliance with treatment regimens. Many of the highest "utilizers" of medical services are individuals who have frequent medical crises precisely because they fail to adhere to treatment protocols (e.g., diabetics who don't control their sugar intake or insulin properly or patients with multiple medical problems who can't follow complex medication regimens). Identifying the cognitive or emotional reasons that might cause this "non-compliance" can be crucial in improving outcome and reducing unnecessary services. A recent study at Massachusetts General Hospital, for example, looked at the factors contributing to non-compliance in patients with the highest utilization of services. Using psychological assessment techniques they were able to identify cognitive and emotional factors (e.g., patient who were too confused to follow complex instructions, or too depressed to remember appointments) that led to failures to follow recommendations and consequent emergency room visits or hospitalizations. By addressing these specific factors, they were able to improve patient outcomes and achieve cost savings in the millions of dollars.