Amputation: preoperative psychological preparation.

More than 90 percent of all amputations are now due to the complications of chronic disease. Because most amputations can be anticipated, the preoperative period allows the opportunity for psychological preparation of the patient. This article highlights the important contribution family physicians can make before patients undergo amputation. Common patient reactions before and after amputation are reviewed, and an illustrative case is described. Our experience and review of the literature suggest that psychological intervention during the preoperative period is associated with a less complicated postoperative adjustment and grieving experience. The family physician can promote patient adjustment by providing accurate information, eliciting unspoken fears, and encouraging the involvement of the patient's family. By emphasizing the patient's enduring characteristics and his or her past coping ability, we believe that family physicians can lessen the psychological distress of amputation and facilitate adaptation.