Psychological testing can help you clear up questions about psychiatric differential diagnosis and treatment planning, but only if your patients make and keep appointments for the tests you recommend.
Based on my observations as a psychologist who administers these tests, factors that undermine patient follow-through include patient or family resistance, prohibitive managed care policies, and limited availability of psychologists who perform testing. I suggest 7 practices that may enhance your patients’ adherence.
Familiarize yourself with best practices in psychological testing—including indications and contraindications—by consulting standard references,1 taking a continuing education overview course, or attending in-service training with local psychologists.
Encourage your patient to find out if his health insurance covers the recommended testing. For example, few—if any—managed care plans cover testing for learning disorders, and some will not reimburse for testing when the primary rule-out diagnosis is attention-deficit/hyperactivity disorder. Plans may be more likely to cover testing when you frame the referral in terms of a differential diagnosis or need for clarity regarding treatment planning.
Maintain an updated list of well-regarded, established clinicians experienced in psychological testing. Children and adolescents should be evaluated by psychologists specializing in pediatric patients, and elderly adults should be seen by clinicians with experience in geriatric neuropsychology.
Educate patients about your reasons for the referral. Refer to earlier discussions when you and the patient were in broad agreement. You might say, for example, “You have wondered whether your forgetfulness is related to depression. Testing can help clarify this issue for us and move treatment forward.”
Remain empathic to characterologic resistance to psychological consultation. Patients with borderline personality disorder might experience a recommendation for testing as abandonment or coerced separation, narcissistic patients may fear humiliation or shame, and obsessive patients may become anxious about failing to “measure up” to some idealized standard of test performance.
Consult with the testing psychologist when you have questions about the clinical value of a formal referral or insurance coverage. Facilitate patient compliance by calling or forwarding the referral to the testing psychologist, who then can write a letter reminding the patient about the referral.
Provide reading materials about psychological testing in your waiting room to help demystify these procedures and encourage patient interest and adherence.