Human doctoring: bringing authenticity to our care.

Increasingly, doctors are looking for ways to treat the whole patient--mind, body, and spirit, disease and illness. To accomplish this, doctors must establish authentic relationships with their patients--that is, relationships in which the life experiences and knowledge of both participants are acknowledged and respected. Physicians must be aware of everything they bring, both as persons and as professionals, to every clinical encounter. In this article, the authors discuss a hypothetical case of a teenaged girl suffering from recurrent coldsores and the possible ways her physician might handle her case. They analyze the differences among the three scenarios, using them to highlight ways physicians can work to achieve authentic and mutually beneficial relationships with the people in their care.     

Integrating public health into medical education: community health projects in a Primary Care Preceptorship.

Physicians must integrate care of populations with the care of individual patients to function optimally in today's health care environment. With this understanding, medical school curricula are increasingly addressing the skills and knowledge of public health along with those of clinical medicine. The University of Utah School of Medicine in 1997 revised its four-year curriculum to increase the teaching of topics needed by future physicians, including public health. This report describes one course in the curriculum, the Primary Care Preceptorship (PCP), a fourth-year, six-week required rotation that assists students in learning about the health needs of a community along with providing primary care for its individual residents. Students in the PCP spend approximately 60% of their time in clinical primary care and 40% completing a community health project. In the first year of the PCP, 32 students completed projects on clinical problems, 27 on community health needs assessment, 26 on patient education, and 15 on epidemiology.     

Integrating health and mental health services in schools: psychologists collaborating with primary care providers

This article reviews recent trends, developments and empirical support for the expansion of psychological practice to include school-based treatment and management of serious and chronic medical conditions, including somatization, in collaboration with primary health care providers. Trends and developments reviewed include (a) the expansion and integration of health, mental health, social and community services in schools, (b) the rapid growth of school-based health centers (SBHCs), (c) psychology's increased involvement in the collaborative treatment of chronic and serious medical disorders, (d) recent federal and state legislative initiatives, and (e) cost-driven marketplace changes. Lack of empirical data specific to collaborative psychologist-health care provider collaboration in schools and SBHCs, particularly around somatization, is discussed. Ethical and legal, professional, and reimbursement issues that must be addressed if psychologists are to practice in this emergent arena are identified. This article calls for research to document both the clinical effectiveness and cost-efficacy of collaborative psychologist-primary care provider intervention in schools and SBHCs.     

Clinical health psychology institute: Integrating clinical health psychology into primary care settings

This special section of the Journal of Clinical Psychology serves as the proceedings for the inaugural Clinical Health Psychology Institute (CHPI). The goal of the CHPI was to provide attendees with a practical, “hands‐on” integration of clinical health psychology research and applied services for primary care practice. This primary care special section is a collection of some of the lectures presented during the one day conference. Dr. James' article on integrating clinical psychology into primary care settings serves as a beginner's guide to primary care integration and how and where to start a primary care program. Additionally, Drs. Earles, James, and Folen provide the rationale for health psycyhologists prescribing non‐psychopharmacological agents, as well as an overview of the clinical pathway model for psychologists to prescribe non‐psychopharmacological agents for the treatment of obesity. Lastly, Dr. Robin Miyamoto provided an article to serve as a guide for utilization of the codes to enhance reimbursement and assist psychologists in developing sustainable behavioral medicine practices. © 2006 Wiley Periodicals, Inc. J Clin Psychol 62: 1205–1206, 2006.     

A primary health care team manifesto. Adelaide Medical Centre Primary Health Care Team.

Over a two year period an inner city primary health care team constructed a manifesto which defined the common aims and objectives of the team. The statement was not comprehensive, but it served a variety of purposes. Audit was made explicit and a framework was provided for the team's annual report. The manifesto has proved useful for trainees and other new members of staff. It has given the team a sense of direction, and it is hoped that it will foster teamwork through team members feeling that they have 'ownership' of the plan. The manifesto was conceived in advance of the government's white paper and new contract for general practitioners. It addresses the perceived health needs of the practice population in a practical way. Other primary health care teams may wish to adapt or use the framework of the manifesto to produce their own version.     

The impact of the changing health care environment on the health and well-being of faculty at four medical schools.

PURPOSE: Increased pressure for clinical and research productivity and decreased control over the work environment have been reported to have adverse impacts on academic faculty in limited studies. The authors examined whether work-related stressors in academic medicine negatively affected the physical and mental health, as well as life and job satisfaction, of academic medical school faculty. METHOD: A 136-item self-administered anonymous questionnaire modified from a small 1984 study was distributed to 3,519 academic faculty at four U.S. medical schools following institutional review board approval at each school. Validated scales measuring depression, anxiety, work strain, and job and life satisfaction; a checklist of common physical and mental health symptoms; and questions about the impact of institutional financial stability, colleague attrition, and other work-related perceptions were used. Responses were analyzed by sex, academic rank, age, marital status, faculty discipline, and medical school. RESULTS: Responses were received from 1,951 full-time academic physicians and basic science faculty, a 54.3% response rate. Twenty percent of faculty, almost equal by sex, had significant levels of depressive symptoms, with higher levels in younger faculty. Perception of financial instability was associated with greater levels of work strain, depression, and anxiety. Significant numbers of faculty acknowledged that work-related strain negatively affected their mental health and job satisfaction, but not life satisfaction or physical health. Specialties were differentially affected. CONCLUSIONS: High levels of depression, anxiety, and job dissatisfaction-especially in younger faculty-raise concerns about the well-being of academic faculty and its impact on trainees and patient care. Increased awareness of these stressors should guide faculty support and development programs to ensure productive, stable faculty.     

Teenagers' health concerns: implications for primary health care professionals.

Four hundred and eighty five students, aged 13-15 years, at nine comprehensive schools in the London borough of Brent completed a questionnaire about health-related behaviours and health concerns. Among general health concerns, most prominent were weight, acne, nutrition and exercise. There appeared to be a considerable unmet need to discuss sexual development, sexually transmitted diseases and contraception. A substantial proportion (16% of the girls and 3% of the boys) reported sexual abuse, but few wished to discuss this with a doctor or nurse. Although a relatively high percentage of the students smoked and a smaller percentage used alcohol or drugs regularly, there was little concern or interest in discussing these matters with a health professional. Most of the schools did not have a formal health education programme, and in none of them were health professionals available for discussion of the issues under study. There appears to be a need for more comprehensive health education in schools and for primary health care professionals, particularly general practitioners to raise these issues opportunistically with their teenage patients.