OBJECTIVE: We sought to develop a typology of physicians' responses to patients' expressed mental health needs to better understand the gap between idealized practice and actual care for emotional distress and mental health problems. STUDY DESIGN: We used a multimethod comparative case study design of 18 family practices that included detailed descriptive field notes from direct observation of 1637 outpatient visits. An immersion/crystallization approach was used to explore physicians' responses to emotional distress and apparent mental health issues. POPULATION: A total of 379 outpatient encounters were reviewed from a purposeful sample of 13 family physicians from the 57 clinicians observed. OUTCOMES MEASURED: Descriptive field notes of outpatient visits were examined for emotional content and physicians' responses to emotional distress. RESULTS: Analyses revealed a 3-phase process by which physicians responded to emotional distress: recognition, triage, and management. The analyses also uncovered a 4-quadrant typology of management based on the physician's philosophy (biomedical vs holistic) and skill level (basic vs more advanced). CONCLUSIONS: Physicians appear to manage mental health issues by using 1 of 4 approaches based on their philosophy and core set of skills. Physician education and practice improvement should be tailored to build on physicians' natural philosophical proclivity and psychosocial skills.
OBJECTIVE: We sought to develop a typology of physicians' responses to patients' expressed mental health needs to better understand the gap between idealized practice and actual care for emotional distress and mental health problems. STUDY DESIGN: We used a multimethod comparative case study design of 18 family practices that included detailed descriptive field notes from direct observation of 1637 outpatient visits. An immersion/crystallization approach was used to explore physicians' responses to emotional distress and apparent mental health issues. POPULATION: A total of 379 outpatient encounters were reviewed from a purposeful sample of 13 family physicians from the 57 clinicians observed. OUTCOMES MEASURED: Descriptive field notes of outpatient visits were examined for emotional content and physicians' responses to emotional distress. RESULTS: Analyses revealed a 3-phase process by which physicians responded to emotional distress: recognition, triage, and management. The analyses also uncovered a 4-quadrant typology of management based on the physician's philosophy (biomedical vs holistic) and skill level (basic vs more advanced). CONCLUSIONS: Physicians appear to manage mental health issues by using 1 of 4 approaches based on their philosophy and core set of skills. Physician education and practice improvement should be tailored to build on physicians' natural philosophical proclivity and psychosocial skills.
Authors: John Furler; Renata Kokanovic; Christopher Dowrick; Danielle Newton; Jane Gunn; Carl May Journal: Ann Fam Med Date: 2010 May-Jun Impact factor: 5.166
Authors: Abigail M Crocker; Rodger Kessler; Constance van Eeghen; Levi N Bonnell; Ryan E Breshears; Peter Callas; Jessica Clifton; William Elder; Chet Fox; Sylvie Frisbie; Juvena Hitt; Jennifer Jewiss; Roger Kathol; Kelly Clark/Keefe; Jennifer O'Rourke-Lavoie; George S Leibowitz; C R Macchi; Mark McGovern; Brenda Mollis; Daniel J Mullin; Zsolt Nagykaldi; Lisa Watts Natkin; Wilson Pace; Richard G Pinckney; Douglas Pomeroy; Alexander Pond; Rachel Postupack; Paula Reynolds; Gail L Rose; Sarah Hudson Scholle; William J Sieber; Terry Stancin; Kurt C Stange; Kari A Stephens; Kathryn Teng; Elizabeth Needham Waddell; Benjamin Littenberg Journal: Trials Date: 2021-03-10 Impact factor: 2.279