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Primary Care Practitioners and Psychotherapy: Time to Talk

(PSYCHIATRIC TIMES) - As someone who has been involved in health care education for 40 years and who was a counselor in a private mental health practice for 24 years, I appreciated Dr Joseph Lieberman’s article on the role of the primary care physician (PCP) in the treatment of mental illness (CONSULTANT supplement, April 15, 2003, page 24). Psychology and nutrition have historically been something of a veneer on the overall education of both physicians and physician assistants. Dr Lieberman is on target when he suggests that the training of PCPs needs to give more emphasis to the recognition of mental disorders in patients who generally present with physical complaints. If the PCP can recognize an emotional disturbance and deal with it, management of the physical problem is often enhanced. However, Dr Lieberman’s discussion left me with the impression that he believed the goal was to help PCPs learn to diagnose an emotional problem and then prescribe the correct medication. While it is true that some emotional disturbances can be treated with medication initially—and at times solely—PCPs must learn to recognize those disturbances that are better treated by a mental health therapist, so that the effectiveness of a medication can be maximized through group or individual therapy. In many emotional disturbances, the personal attention a patient receives in therapy sessions is often an integral aspect of treatment. We are not yet at the point where PCPs are able—or want—to devote the kind of time and energy to patients that effective therapy requires. At our institution, we train physician assistants in the same basic philosophy and approach that Dr Lieberman describes (including use of the BATHE protocol [background, affect, trouble, handling, empathy]). However, we also teach students the limitations of the primary care provider with regard to psychotherapy, as well as techniques for referring patients to a psychotherapist with whom they will be comfortable. —— Robert C. Grosz, EdD
Professor and Course Director
Physician Assistant Program
Nova Southeastern University
Fort Lauderdale, Fla

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