(Editorial) Southern Medical Journal

____(2006) Obese people may be more sensitive to pain.(NEWS Breaks)(Brief article) Nutrition Today

PORTER, LAWRENCE C. WAMPLER, RICHARD S (2000) Adjustment to Rapid Weight Loss. Families, Systems & Health

Rubin, Jay J. (2005) Psychosomatic pain: new insights and management strategies.(CME Topic: Psychosomatic Pain) Southern Medical Journal

Tucker, Miriam E. (2005) Depression tied to poor adherence to cardiac Rx: results of two studies show that use of aspirin and [beta]-blockers was lower in depressed patients.(Psychosomatic Medicine) Clinical Psychiatry News

METHODOLOGY

This study will seek to determine whether or not obese post operative patients have a higher incidence of psychosomatic disorders and illnesses than non-obese post op patients have.

Need for study

The need for this study is evidenced in several ways. There has been a lot of research done regarding obesity. There has been a lot of research done about psychosomatic illness and disorder, however there has been little research done about the incidence of psychosomatic illness in post op obese patients. This is an important question to answer for several reasons. The post operative care of any patient can be time consuming and costly. If a patient has psychosomatic issues along with the biological recovery issues it can mean additional physician visits, additional, medications and therapies and additional time spent on the patient that could have been better utilized.

With the ever increasing need to keep insurance costs to a minimum it becomes important to curtail time used on patient visits that are not necessary, including visits based on psychosomatic events.

In addition it is important that the patients recover with as few complications as possible. Past literature does indicate that obese patients already have a higher incidence of psychosomatic illness. This can translate into non-compliance with post-operative instructions according to one recent study. This non-compliance could reduce the effectiveness of treatment as the patient does not comply with basic needed steps to recover.

The need for the study become evidence when it will impact the future recovery of obese post op patients thereby reducing cost to the consumers as well as the medical profession.

STATEMENT OF PROBLEM

There have been many studies done on the different elements of this issue but there has not been research conducted on the actual question about the possible correlation of all of the elements combined. This study will address the direct question.

METHODOLOGY

There were several possible research methods that were examined and rejected for this study. The final decision was that the survey method will be used for this research. It is important to understand why other methods were rejected to understand why the survey method was chosen as the best for this particular project.

There are many methods that can be used in the field of research. Among the more popular methods used are the survey, the case study, the literature study and the experiment.

Each of these methods has strengths and weaknesses and they are individually applicable to research as they match up with the study need. In the case of literature reviews it is a popular method when one wants to further investigate something that has already been scrutinized. Literature revises are useful when a topic is historic or extremely popular and the research team wants to analyze what has already been discovered about it. It is conducted through the use of seeking out published studies on the topic and analyzing their results. With this method it is important to seek out studies that yielded different results so that the current study can remain pure.

This method was not acceptable for the study that will be conducted regarding the psychosomatic incidence in obese post op patients when compared to the incidence in non-obese patients because little to no research has been conducted on the topic. For a literature review to be effective it is important to be able to gather a cross section of studies and evaluate them against each other to draw a conclusion. If little to no research has been done the analysis will be incomplete.

CASE STUDIES

Case studies are valued because they allow the individual case to be studied in depth and at length. A case study allows for conversations that can be very open ended and for length observations that can answer questions more in-depth that many other methods can do.

Case studies are excellent forms of research for many studies but for this one it will not provide enough data to be able to provide an accurate portrayal of the situation.

Experiments are another respected...

There are many experiments conducted each year in the field of research. Research has assisted the field of medicine in the development of procedures, medications and improvements to treatments. Experiments allow a hypothesis to be tested first hand and provide actual observation of the hypothesis in motion.
In the case of this study however, an experiment would not be feasible as it is testing the post operative incidence of psychosomatic disorder in obese patients.

For the purpose of this study the research team will use a survey method. The survey will be completed by physicians and surgeons that have been involved in the post operative treatment of patients who are obese and patients who are not obese.

The population for this study will be physicians. The participants will be those who send back the survey and it is completed correctly.

The participants will be located through hospital rosters. The surgeons and physicians will treat adult patients and will be sent a pre-information packet asking if they would be willing to participate in the study.

There will be 50 pre-information packets sent out with a one month window to have the answers back.

Of those who agree to participate the survey questions will be sent with instructions on filling them out. They will be asked to assess five post op obese patients and five post op non-obese patients each.

The survey will be divided into three sections. The first section will gather general demographic information. It will ask the physician's background, specialties, number of completed surgeries this year if any, number patients within the practice and type of services offered.

The second section will examine the patient's profiles. It will address each of the 10 patients that the physician will evaluate. The name of the patient will not be asked to be able to maintain the privacy of the patient in question and to eliminate the need to obtain permission for that patient's information to be used in the study. In addition there will be no identifying questions asked about the patient. The patient's history, age, weight, and need for surgery will be asked for and the date of the completed procedure.

The third section will be the most involved and will ask the doctor to detail how many post operative visits were provided, including in the hospital. It will ask what those visits were for on an individual basis. This means the doctor will be asked to describe the visit and its purpose and its date.

The doctor will also be asked to answer as to whether or not the patient fits any of the following criteria:

Was the patient displaying any of the following behaviors? If so which ones?

Demanding excessive attention. The patient or spouse may assault your office with repeated phone calls or may show up in your office without an appointment. Alternatively, and more dramatically, the patient may go to the emergency room unnecessarily. The patient is seeking validation of physical suffering. Usually the patient is also trying to convince the clinician that the symptoms are severe enough to warrant more tests and/or more medication (Tucker, 2005)."

Malcompliance with carefully planned and discussed treatment (Tucker, 2005).

Anger and false accusations about "mistreatment." For this reason, always have a chaperone even if the patient brought a spouse or friend.

Relentless pursuit of muscle relaxants or narcotics (ie, drug-seeking behavior).

Convincing you to order or perform invasive tests or procedures after other evaluations yield no diagnosis. Thereafter, imagined side effects or actual complications may occur. The clinician is seen as the perpetrator of the procedure, becomes responsible for many additional symptoms, and remains "joined" to this patient. This may explain why some surgeons often give unwarranted and extraordinarily generous disability and impairment "rewards" to histrionic patients who are unhappy with the outcome of an operation. Perhaps this is given as a remedy to appease a dissatisfied customer and to avoid potential litigation. However, the unwarranted legitimization of disease could ultimately strengthen an unfounded lawsuit from a patient rendered "totally disabled (Tucker, 2005)."

The doctor will be asked to track the post op visits, treatments and follow up for six months before sending the survey back.

DATA COLLECTION

At the seven-month mark the surveys that have been received will be individually accessed with the information being logged into a data base to determine the outcome.

LIMITATIONS OF STUDY

The research team has to depend on the physicians to be diligent in the survey completion and the return of the surveys. They are also being asked to pick the patients which…