[Music] if you or a loved one has been referred for psychological testing you probably have some questions about what to the process of testing may even in timidating but in this episode of being well Sarah Bush Lincoln's doctor Derek Phillips will explain how the process is designed specifical you when Sarah Bush Lincoln opened in 1 it was with the promise to serve the community's health care needs it has grown into a two hospital system with nearly 60 clinics that provide trusted Compassionate Care for over 50 years Horizon Health has been keeping you and your family healthy and although some things have changed Horizon Health's commitment ever-changing needs of our community has remained the same Horizon Health 50 years strong Carl is redefining Health Care around you innovating new Solutions and offering all levels of care when and where you need it investing in technology and research to Healthcare Carl with Health Al always at the Forefront to help you thrive [Music] welcome back to another episode of being well I'm your host Lacey Spence and today we are welcoming a new guest to the show all the way from Sara Mattoon we've got Dr Derek Phillips with us today welcome to being well thank you honored to be here of course and so as a new guest my favorite thing to do is open the floor let you introduce yourself and talk a li you ended up in the white coat there so go ahead take it away sure thank you yeah well it's great to be here um I am from not too far away I was born and raised in Casey um so um very very nearby still at um we don't have near as many big things here not near as many big true and uh honestly those were kind of new to me too because those weren't there when I was growi they're very cool um I you know I left home for a while to do all the schooling and then I came back to work at Sarah Bush about 60 years ago okay and so I'm in the Department of Neurology at Sarah Bush at the main campus and I worked there full time and I'm really enjoying it so far well fantastic I'm excited to be covering a topic that's new to me we're going to be ps ychological testing and assessments and you and I chatted a little bit before we started rolling here th good place to maybe start is to to people what is the difference betwe a psychologist and a psychiatri it's a great question it is one that get pretty often I think the the best way to differentiate them is that psychiatrists go to medical school and then our medical doctors who specialize in mental health they prescribe medication they do Psychotherapy sometimes they do other sorts of treatments like um people probably heard of shock therapy in the past that is still a thing and we do that at Sarah Bush so psychiatrists are going to be the ones that are overseeing that overse process and the care and usually work in hospitals but some work in private practices as well and then relatedly a clini psychologist doesn't go to medical school but we do go to graduate school it's usually a four to five year program after undergrad and we our doctoral level providers either have a PhD or another degree called asciety which is a more clinical degree than the PHD but then we also do psychotherapy but then one of the other things that really makes us kind of unique is the psychological testing that you mentioned so that's something that is pr special to what we do and one of the things that we're able to offer that probably aren't going to get anywhere else but it's really where we're measuring either someone's personal or we're measuring their their thinking their cognition for various reasons you know could be if someone is concerned about having ADHD if they're concerned about having dementia if they've had some sort of injury to the brain things like that is what we're testing for to see how the brain's working and so in case I didn't say it and the folks at home didn't pick up on it the aisle are you on yes I am a ps ychologist okay by training yes fantastic so as we're talking about testing what is that clinical psychological assessment how does this kind of take place so most of the time people primary doctor and tell them what's going on you know what they're noticing and then the primary would then refer to me so I think the best example is you know someone is having trouble paying attention and they think t ADHD so they go to their primary doctor they tell them about it and then their primary says oh well let's have you go and have some psychological testing done to confirm that diagnosis to make sure that we really know what the diagnosis is so that we know the treatment will be correct so that's usually how that happens um so they see me a specific process of getting to know them doing the testing and then giving them the results of the testing that they can then use to get treatment whether that's with their primary or maybe with a psychiatrist depending on what we find in the testing so you've mentioned a few of the conditions ADHD potentially dementia kind of walk me through a few of those scenarios that when I need to make sure that I'm seeking help and what that kind of looks like yeah I think the the bottom if you're have if you're experiencing anything to do with your thinking and it's causing you problems in your life then that's when you would want to seek help some thing an inconvenience but they're not really interfering with our work or with school or with family but when they are starting to interfere with those things then that's when you would want to go um you know again probably to your primary just to get a good what's going on and then they know where you need to go maybe they'll treat it themselves maybe you do need specialist but I think that's the bottom line because there are a lot of things I like to say this our brains are great they're they're very good but they're not perfect and so we shouldn't expect there to be no problems ever yeah even when we're young we still expect the brain to be kind of inefficient at times just like you know other other organs are so it matters how much it's happening the severity of what's happening and if it also if it goes away on its own or if it doesn't so obviously if it doesn't you would want to seek help or if it's causing lots of prob in your life and I don't know if you can speak to it without it being such an individual basis but I mean is there like a time frame where it's like okay this is more than just something I should shrug off as you know like a a week a month yeah that is a good question it yes it does depend on what the condition is you know for people that are having attention problems you know and and it's ad and they're thinking it's ADHD for tha specific because ADHD is a childhood onset problem so it always starts in childhood it doesn't always get diagnosed in childhood though so I sti have lots of adults coming and being referred to confirm that diagnosis because you know maybe their parents weren't really tuned into that when they were a child that's just how they are yes you hear that unfortunately you hear a lot of their lazy you know those are unfortunately things that um people with ADHD here often so I would say with that it's probably it probably will have been there your whole life if it's ADHD um if we're talking more along the lines of dementia that is typically in our older adult populations on average that's around age 65 that those problems at least begin but those are going to be years long and you'll see a pretty gradual decline over you know multiple years so I would say if it's less than that definitely keep track of it tell your doctor about it but it may not be to the point where there needs to be any intervention Okay so we've definitely hit that it can be a wide variety of Ages that seek your treatment a few other conditions you had mentioned prior to us starting long covered and then also effects from chemo or radiation let's kind of dive into those yeah well you know we lot about the the long-term effects of covid okay but but we have I I personally have seen multiple patients in my office that had coveted 19 and had um you know lots of symptoms I mean for me most of them were you know they wer memory symptoms or cognitive symptoms and you know it's months and months later and they're still having these problems because we wouldn't expect those to linger after you know a certain amount of time after the your kind of negative for for covid yeah for some people we've just found that for whatever reason it was especially hard on their nervous system and these these symptoms are lingering and so in that case I I do do some testing and um looking to see if there are impairments if there are then job to try to narrow it down and figure out as best I can if it is the most likely caught a reason that it was from covid or if it's from another condition that the patient has so it can be a little tricky because it's hard to prove that it was from covid yeah um especially if someone has other conditions that that are there too for people that have had chemo or radiation this is also unfortunatel not a rare occurrence after someone goes through chemo and radiation okay um you know the reason that they are effective with cancer is the same reason why they can cause other problems because unfortunately the treatments alth they're getting better they're not very specific when you have chemo it's killing cancer cells yeah unfortunately it's also killing healthy cells so so depending on what kind of cancer it is what kind of specific radiation or chemo you had it's possible that you could have some cognitive problems you know even years after stopping the treatment unfortunately it it doesn't always kind of go back to normal even once you complete the treatment so pretty similar process I'm going to evaluate the person check their thinking and then if there are any impairments I'm again going to try to determine if the most likely cause of that is from the chemo irradiation or if potentially it's from multiple conditions so let's back up a little bit so as you're talking about the test might be a little bit curious as to once I'm in that appointment how does that kind of go can you walk us through that sure so for the typical patien going to see me three times okay the first deployment is going to be me taking a pretty comprehensive intensive history so this includes their so history medical history psychiatric history really the the whole the whole story then in the second appointment is when I'm actually going to be doing the testing itself okay most of ar e verbal although some are written some are computerized but essentially I am asking the patient to do tasks that are requiring them to use those various cognitive skills so of course memory but also I'm testing their attention their problem solving their speech the visual spatial awareness and depth perception and things like that and so again I'm measuring that by you know verbally asking them to do things think about things then they give me an answer sometimes things are on paper where I'm asking them to sometimes it's just rating themselves and then also there are some things that are computerized where I kind of set them up I in structions and then they follow the prompts on the computer so it's a combination of different styles of doing this um that second appointment is quite long it can range anywhere from two to four hours you're getting really pers depending on yes it can it's pretty anxiety provoking for most people because they've never been through it before most people haven't and so t they do tend to come in with quite a bit of anxiety so a lot of the appointment too is helping them keep that under control sure so that they're able to you know actually complete the tests and that it's not negatively affecting their performance right you don't want t to look worse than they are exac so after they finish that two to four hour appointment I see them one more time where I'm actually delivering the results to them so I usually have a printed out copy of my report that has all the results in it that I've written I go over the contents of that ab out what the scores were on the tests what they mean what is the diagnosis if any and where do we go from here what are my recommendations What treatments are likely to help and where do they go to do that do they go back to their primary yeah do they need to ne urologist a psychiatrist so I'm helping them at least guide them towards what resources they need after that and then just to close the loop I also send the report back to the referring provider you know again usually that's the primary but sometimes it's a neurologist or psychiatrist or I mean really any specialty and so just to close that Loop and to make sure that they know I've completed my part of assessment and that you know it's kind of time to take that up and continue on with the process so as we are look those options of what's next can some of them be medicinal some of them therapeutic is surgery ever needed medication is often a recommendation okay depending on what we find you know if if it's a memory problem that we find for example let's say we do confirm its dementia there are some medications out there that help slow down memory loss they don't stop it or reverse it unfortunately we're not quite there yet I wish me too and my patients wish t too but it those are definitely options for people unfortunately we really don't have other Medical Treatments for that there have been a few others that are coming about coming around and being approved by the FDA but at this point they're they still have mixed reviews yeah and so we tend to go with these that are more established for therapy yes I would say this probably the number one recommenda that I'm giving people because of w they're seeing me um so you know let's say someon in they want to know if they have ADHD we do the assessment and that's not what I find let's say that they have severe anxiety they have severe depression well those things also very commonly cause attention problems and so what do we do to fix the attention problems we fix the an and depression and so a lot of times I'm referring them to psychotherapy to try to get a better handle on the anxiety and depression depending on how se those are medication may also be a recommendation at the same time yeah but therapy really it has really t especially if if we look at people's long-term recovery therapy is better for that so I I definitely talk about that a lot and I'm really encouraging my patients to pursue that I can't think of a reason why I re commend surgery although now that it comes to mind you know there are some people where even though I don' obesity it comes into the picture sometimes because of course it affects people's mental health yeah and so sometimes I will at least say you know maybe I'll send a referral to our our weight management clinic sure at least to get some options whether they're medical op options will be up to that we may briefly talk about surgery there are also times where I'm doing psychological clearance evaluations for people who want to undergo bariatric surgery okay because most insurance companies require that they have psychological clearance before they'll pay for that sure all in realizing that um that you all are talking to each other the different fields instead of kind of getting siled being able to have more of a cohesive comprehensive treatment plan absolutely can really help you not miss conditions and let them go under the radar um is there anything else about this process or this topic that I haven't asked about that might be good pe ople to know well I would just say um don't be scared of it I think a lot of people um you know when you think of yo ur primary doctor if you think through it you probably have a pretty good idea of what's going to happen when yo that appointment you know the nurs going to get you they're going you it's going to go i know they're going to review medication the doctor's going of those things you kind of th ink for what I do it's not well known and so people tend to be very you know sometimes afraid anxious very reluctant to be there because they don't know what's going to happen so I would just say that for the most part we're just going to be talking yeah I I do like to th at my evaluation since I'm a psychologist is not going to be um you know giving you medicine in the office or giving you a shot or drawin your blood or doing a scan you know o of your brain or another body part we're just going to be talking I may do some testing with you but like I said earlier the testing is just it's it's talking also or it's on paper or it's on the computer um you know I don't have p into my office and lie down on the and tell me their feelings like yo like we all have seen many times in TV and movies so I would just say you kn be scared of it um if you have an issue that you're concerned about that that you think a psychologist might help with or that your primary things the psychologi might help with um I would say you know give i because um you know Sarah Bush and our area we're kind of we're in what we call a mental health desert here and so there aren't a lot of us around so I would just say take advantage of of the resources we do have you know we have a psychologist we have psychiatrists we have counselors we have social wo all even within Sarah Bush so I would just say you know try to give yourself the chance to get better yeah you know if you think that that possib would be a way that would help you yeah and don't let stigma stop you I mean mental health is just as important as physical health It's just someti harder to recognize since we it absolutely absolutely I you know think that the stigma has improved over the past few years especially with covid uh finally getting yes finally you kn but also access has improved too since you know really almost everyone moved to doing things via tele you know where they're doing it by Audio or video that's really helped with tran problems with stigma because then you don't have to leave and be seen going into a mental health clinic things that so we definitely still have a long way to go with stigma but I have seen it improve over the past few years and I think I think we'll keep moving in that direction our fingers are fast la st couple of minutes I have to ask are there any cases that maybe of course i general terms but that stick out to you where you've really been able to see what someone's going through unlock it for them and work them through a care plan yeah in fact just this week I was giving results to one of the patients that I did psychological testing with and this patient was referred for ADHD evaluation and it was pretty obvious during our three appointments that she was already pretty convinced that that is what was going on yeah and so when she got to that last appointment where I'm going over results when I said I don't think you have ADHD her face was surprised yeah to say the least and she was really just in disbelief that that was that Dr Google was wrong yes the doctor Google was wrong the first time everyone's ever been guilty Dr Groupon they scare me a little but we went through the scores yeah which were pretty convincing that she didn't really have those type of attention problems that we would see in ADHD what she did have a lot of of was bipolar disorder okay and so we had a conversation about how much especially psychiatric disorders mimic each other and overlap with each other we really don't have these really solid lines between each of the conditions there's there's tons of overlap but when I went through with her again all of the symptoms of bipolar disorder she looked at me and she said you're describing me and she I mean I could tell just looking at her but she also said like this has kind of blown my mind today to know that that's not what this is and this is what it is and that you know it's a completely different treatment even from what she had al been treated with it's a completely different treatment so I rea least it seemed like she was really leaving with hope to get better even though it wasn't what she thought it really was yeah to finally be seen and known and that has to be I mean just life-changing for her yeah I mean I I certainly hope so just I really enjoy being able to spend that amount of time with people um and being able to really dig in and you know I think otherwise that would have been missed pretty easily ye we're under a minute here but um just want to give you the floor ar there any words of encouragement final doctor's orders you'd like to share with us before we wrap u um you know in general I think communication is so important and that includes communicating about what you're feeling what you're going through we have feelings for a reason and we have to feel them as long as they're there we have to feel them until we don't they're going to be there until they're not and so I I really encourage people to not try to just stuff those down talk to someone about it it can be a friend or you know if it gets to another level then a professional I think is is needed but it's so important to talk through these things because um you know people the people that care about you they want to know how you are and how you're feeling a um but they're not going to know sometime just be verbal be communicative and um you know let let people know how you're doing let them help you all right we'll speak up and we'll speak out Dr Phillips thank you so much for coming on being well I've enjoyed ha thank you very much my pleasure of course and we thank our viewers for joining us for this episod well and I hope to see you nex Carl is redefining Health Care around you innovating new Solutions and offering all levels of care when and where you need it investing in technology and research to Healthcare Carl with Health Al always at the Forefront to help you thrive for over 50 years Horizon Heal been keeping you and your family healthy and although some things have changed Horizon Health's commitment to ev er-changing needs of our community has remained the same Horizon Health 50 years strong when Sarah Bush Lincoln opened in 1977 it was with the promise to serve the community's health care needs it has grown into a two-hospital system with nearly 60 clinics that provide trusted Compassionate Care [Music]