The Medical Psychologist

After 12 years mentoring and collaborating with physicians, advance practice nurses, and other medically trained clinicians, and caring for hundreds of medical patients, I am clear about the great need for, value of, and barriers to integrating psychology and medicine. And I know how to do it. But as I wrote in 2018 for the Florida Academy of Family Physicians, system change is difficult. Read More

As a scientist-practitioner, I am schooled in the value of research and scientific evidence. As a clinician and educator, I aim to serve and empower the vulnerable, and ease suffering. Suffering takes many forms, some medical, some psychological. While I can most directly personalize your care if you schedule an appointment, not everyone will be able (or choose) to see me. Therefore, to maximize my ability to help you, I also offer clinically relevant information via my monthly newsletter The Medical Psychologist. Content is informational and does not constitute medical advice but does provide knowledge and insight to guide you as you navigate your own clinical experiences in our increasingly complex, impersonal, health care system. Newsletter content includes common clinical scenarios and easy to understand summaries of research and advances in knowledge about common clinical issues. (I am a peer reviewer for several medical journals.) While by now I am aware of the many national gaps that plague patients, families, and clinicians alike, every person is unique.  To ensure I address issues of personal relevance and benefit to you, please send me your questions, concerns, and desired newsletter topics here and I will do my best to address them in the newsletter.

Given the ongoing discussion of behavioral health throughout the nation and supposed barriers to integrated care (e.g., patient stigma, clinician shortages, desire for a quick fix), below provides a sample of evidence-based newsletter content that might surprise (and hopefully help) you.

-The pioneer who in the 1940s conceptualized person-centered care was not a physician. He was a psychologist, Dr. Carl Rogers.

-The pioneer who in 1969 called attention to the harm of bias based on age (ageism), advocated de-medicalizing geriatric care, and emphasized  therapy rooted in psychological needs (reminiscence/life review), was not a psychologist. He was a physician (psychiatrist), Dr. Robert N Butler.

-The pioneer who in 1977 articulated the need to expand the biomedical model of medicine to include and integrate psychosocial dimensions was not a psychologist nor a psychiatrist. He was a primary care physician (internist), Dr. George Engel.

-The pioneer who in 1980 echoed similar sentiments as above and introduced the concept of behavioral health/behavioral medicine was not a physician. He was a psychologist, Dr. Joseph Matarazzo.

“Shortages”

In contrast to the above insights, neither psychologists nor psychiatrists are integrated into standard primary care. Instead, both remain siloed in mental health settings, often together. The national supply of psychiatrists is approximately 40,000. The national supply of licensed psychologists is approximately 100,000. 

Psychiatrists have largely shifted their practice to focus on medication (“psycho-pharmacology”) while psychologists, because in most states they cannot prescribe, are separated from (rather than integrated into) standard health care.  To date, the health care system’s “solution” has been to cut corners by expanding the role and scope of those already in place such as nurse practitioners and social workers. Pharmacists continue to be integrated as well.

“Stigma”

Among nearly 69,000 patients, when asked whether they prefer discussing their concerns vs medicating them, 3 out of 4 (75%) want to talk. Read More

More recent evidence shows a nearly 40% increase in mental health service utilization following the Coronavirus pandemic. Read More

Clearly system change has not been easy. There have been some reasons for cautious optimism, several of which occurred in 2015, the same year I assembled a team of physicians and psychologists as Editor of a collaborative text calling for integrated care.  Read More

• The American College of Physicians, the nation’s largest internal medicine society, published a position statement advocating for standard behavioral health integration into primary care given the efficacy/effectiveness of psychological interventions and the fact that mental health conditions will be more prevalent than any other by 2020. Read More
• National Academy of Medicine published a comprehensive report identifying the nation’s sub-optimal delivery of psychosocial interventions despite the fact that they are efficacious and evidence-based. Read More
• The Association of American Medical Colleges, the governing body of undergraduate medical education, debuted a new medical school admissions test which includes a behavioral and psychological sciences section for the first time in history. Read More

While all promising steps in 2015, now nearly a decade later, clinical access to psychologists and psychiatrists is still not standard, thus neither is access to biopsychosocial medicine and behavioral health care.   A subscription to The Medical Psychologist can help you stay abreast of these and other developments as you advocate for your own, personal needs in a system that too often instead prioritizes its own. 

Future newsletter topics will include psychedelic treatment, weight loss medication, behavioral pain management, insomnia, fitness to drive, family systems therapy, “mild” cognitive impairment, end-of-life care, caregiver burden, and brain health.  Stay informed, take control of your care, subscribe today.