The family physician and the psychologist in the office together: a response to fragmentation.

It is well known that motives for consulting the family physician, though expressed as physical symptoms, often derive from problems needing a holistic, psychosocial approach. Progressive differentiation between medicine and psychology makes co-operation through referral to the psychologist by the physician quite problematic, in terms of both which patients are referred and the modalities of referral. Acceptance of psychological referral may, in any case, be difficult, due to the social stigma that still surrounds mental distress.The authors report a possible solution in an experiment implemented by the postgraduate Health Psychology School of the Rome University 'Sapienza', entailing joint, direct co-operation between a family physician and a psychologist through the psychologist's presence in the doctor's office during consultations. This allowed direct access to a psychologist in the absence of any filter and without the need for a formal request on the patient's part and a biopsychosocial approach to distress. In a small number of cases, more formal consultation with the psychologist was proposed. Cases were always discussed between the two professionals. To date, the experiment has involved nine psychologists and seven physicians over a period of nine years. It appears to be entirely feasible, though requiring a period of adaptation between the two professionals. Patients have welcomed the presence of the psychologist and, as expected, take a broader approach in reporting their distress.An illustrative case is presented, in which finding the meaning of a symptom avoided unnecessary and costly investigations, and facilitated the patient in taking a new direction in his life.