Patient care and the health-care system benefit when psychologists work effectively with medical practitioners to meet the
preventive, acute and chronic needs of the population, said speakers at the State Leadership Conference. Left to right, APA
President Dr. Suzanne Bennett Johnson, Dr. Robert McGrath of Farleigh Dickinson University, Dr. Benjamin Miller of the
University of Colorado Denver School of Medicine and Dr. John Andazola of LifePoint Hospitals in New Mexico.
are several reasons, according to Benjamin Miller, PsyD, director
of the Office of Integrated Healthcare Research and Policy at the
University of Colorado School of Medicine in Denver.
For one, fragmentation in the health-care system means
that others often don’t hear about successful integration
initiatives and so can’t come together to make a case that
integration should be the standard of care. In addition, there’s
no standardization across models of integration, and people
may use different terms to describe the same model. And while
psychologists are good at collecting clinical outcomes data,
other variables — such as financial outcomes — are crucial
when it comes to making the case for integration.
Psychologists can help make that case, said Miller. To
create more consistency across sites, for example, they could
change the way they document patient care. “I can write a
beautiful narrative note, which has a lot of clinical utility,” said
Miller. “However, what we have to do is think about the age of
electronic health records.” Drop-down menus and standardized
forms make it much easier to pull data from records and show
the benefits of integration, he said.
Andazola offered a physician’s perspective. “I’m the
physician you’re going to integrate with,” said Andazola,
who trains psychology and medical students side by side and
encourages them to consider not just psychological illness but
the psychological aspects of physical illness.
Integration isn’t the same as collaboration or co-location, Andazola emphasized. “We’re not just working with
psychologists,” he said. “They’re involved in everything we do
across the board: We treat patients together.” Psychologists
and physicians see patients in the same setting, which helps
break down the stigma often associated with seeking mental
health services. And they use the same electronic records.
When medical residents graduate and move on to clinics
that don’t integrate behavioral health, added Andazola, they
often feel they can’t treat patients appropriately. “They feel they
don’t have a full armamentarium,” he said.
Promoting integration more widely will require changing
both psychological and medical education, Andazola
concluded. Psychologists need to learn brief interventions,
since 45-minute sessions are incompatible with integrated
care. They also have to learn to talk to physicians. While
psychologists are thorough, he said, physicians are to the point.
And while psychologists don’t make diagnoses until the data
are definitive, physicians make diagnoses based on ambiguous
data all the time. n