When Dr. Justin Kauk asks his patients how they’re doing, he’s not just inquiring about how a broken bone is healing. He’s also asking about their emotional state. And if they say they’ve been anxious or depressed – or if Kauk detects it – there’s someone down the hall who can help.
The Novant Health Orthopedic Fracture Clinic in Charlotte offers something Kauk said is rare in orthopedic clinics in the U.S. – a clinical health psychologist. In fact, he’s never encountered another one.
Kauk is an orthopedic traumatologist. He treats people who have sustained traumatic orthopedic injuries typically immediately after they have happened, but he also sees patients who have had a complication with their healing or an infection relating to their fracture. “Whether it be falling from a 30-foot tree or monkey bars, being in a car accident, having bones not heal properly after surgery, chronic pain – all that falls under my realm,” he said.
The psychological component of an accident falls under the realm of Deanna Denman, PhD.
Denman, like all health psychologists, is interested in the relationships among behavioral, emotional, cognitive and social factors and their influence on health. “My specialty is helping people cope with the psychological effects of medical conditions and illness and helping them with rehabilitation,” she said.
“There are other medical services that have been integrating behavioral health for years,” she said. “With cancer treatment, for example, it's very common to find a psychologist present. But that’s not the case with ortho.”
Kauk and Denman aren’t just treating broken bones. Together, they’re treating the whole patient as part of a carefully coordinated effort to help them recover and live the best possible life after something terrible has happened. And the patient’s mental health is key to that effort.
At the patient’s side
“For a lot of patients, working to overcome trauma involves getting them to stop avoiding what they experienced, to help them intentionally process what they experienced and how that has changed the way they view the world,” Denman said. “A lot of times, when somebody experiences a trauma, they start avoiding reminders of it. For an ortho trauma patient, that could mean avoiding taking care of themselves.”
In fact, patients often find themselves in a scary place. Denman is there to be mentally and emotionally present to help them deal with their fear. “Their fear is reasonable,” Denman said. “I'm there to walk through that with them.
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“When somebody presents with (post-traumatic stress disorder), they may be having nightmares or not sleeping,” she continued. “They tend to be on edge all the time. If they were injured in a car accident, they may have anxiety about driving or riding in a car. They tend to look depressed. Usually when we finish treatment – when they ‘graduate’ – they are back to driving, they are taking care of themselves physically, they're connecting with people and relating with people in ways they want to.”
It’s a much-needed service. Kauk, who’s also medical director of the orthopedic trauma service and the clinic, sees about 25 patients during each clinic session, and he usually deems three or four to be candidates for Denman’s counseling services.
Making a connection, building a relationship
The clinic treats mental health as the priority it is. Kauk doesn’t just mention Denman’s name and suggest the patient call her. He introduces them in person.
“We try to make a connection that day,” he said. “We've designed Dr. Denman’s schedule so that she's in the office during my clinic sessions. So, if there's somebody I think would benefit from seeing her, I’ll make an introduction. She comes into the room, makes a connection and explains a little about what she does.”
If the patient decides to schedule an appointment, it can happen virtually or in person.
From the first appointment, Denman works to build relationships with her patients. “I might start off by letting a patient know that depression and anxiety are very common trauma responses and that we have tools to help. I may connect them to other resources, like physical therapy and occupational therapy, and remind them that their reality right now is not going to be their reality forever.”
And while Denman will be available for as long a patient needs, she doesn’t intend to provide long-term care. “It depends on the person, but I prefer short-term treatment,” she said. “I tend to think that I'm here to give you skills to help you cope. And, in theory, you should be able to take those skills and implement them in your life. You shouldn't have to see me forever.”
Kauk came to Novant Health three years ago to build the orthopedic trauma program. “With the national push to decrease opioid usage and looking at alternative ways of coping with pain and minimizing narcotic use, I saw it as crucial to treat not just the injury, but the entire person,” he said.
The clinic treats a wide range of patients, including a number of low-income, under- or uninsured people and people experiencing homelessness.
“When somebody is dealing with something like housing insecurity, I’m not terribly inclined to even call them ‘depressed,’” Denman said. “They have very real-life circumstances that are challenging. So, I'm going to do everything I can to help get them connected to resources. Novant Health offers transportation for appointments. We try to keep treatment as reasonably priced as possible, and I try to accommodate as many of their needs as possible.”
“I have the best job in the world,” Denman continued. “It's a privilege to meet somebody when they're going through maybe the darkest, or one of the darkest, times in their lives and help support them through that.”
When bad things happens, choose your words carefully
It can be tricky to know what to say to a friend or family member who’s recovering – physically and mentally – from an illness or injury. You want to help, but may not be sure how to approach them. Here are a few tips.