To The Editor:
In "Ethics in Practice. Terminating the Physician-Patient Relationship" (2008;90:208-10), Drs. Capozzi, Rhodes, and Gantsoudes describe one of the difficulties that often arise in clinical practice. The patient has what is often called in psychology "a hidden agenda." The doctor and the patient have different goals for the treatment. The doctor is devoted to treating the physical problem, and the patient is focused on trying to avoid his or her work situation for one reason or another. This is a dilemma in which a psychologist could help.
If the doctor were able to refer the patient for an interview or two, the probability of a positive treatment outcome would be enhanced by making the hidden agenda transparent and helping the patient to make whatever adjustments were necessary to cope with the work situation.
Recent studies have identified a variety of psychological factors that correlate with outcome following total knee arthroplasty and total hip arthroplasty1-4. Pretreatment interventions have been identified as useful for patients who are anxious, depressed, and in pain. In this case, if the patient had been interviewed before treatment, her vocational difficulty might have been identified. As it is, a posttreatment referral might just be the answer and might help the patient to avoid losing her doctor and to have a more positive outcome.