Susan H. McDaniel

Patient trust: Is it related to patient-centered behavior of primary care physicians?

Background:Patients’ trust in their health care providers may affect their satisfaction and health outcomes. Despite the potential importance of trust, there are few studies of its correlates using objective measures of physician behavior during encounters with patients. Methods:We assessed physician behavior and length of visit using audio tapes of encounters of 2 unannounced standardized patients (SPs) with 100 community-based primary care physicians participating in a large managed care organization. Physician behavior was assessed via 3 components of the Measure of Patient-Centered Communication (MPCC) scale. The Primary Care Assessment Survey (PCAS) trust subscale was administered to 50 patients from each physicians practice and to SPs. We used multilevel modeling to examine the associations between physicians’ Patient-Centered Communication during the SP visits and ratings of trust by both patients and SPs. Results:Component 1 of the MPCC, which explored the patients experience of the disease and illness, was independently associated with patients rating of trust in their physician. A 1 SD increase in this score was associated with 0.08 SD increase in trust (95% confidence interval 0.02–0.14). Each additional minute spent in SP visits was also independently associated with 0.01 SD increase in patient trust. (95% confidence interval 0.0001–0.02). Component 1 and visit length were also positively associated with SP trust ratings. Conclusions:Physician verbal behavior during an SP encounter is associated with trust reported by SPs and patients. Research is needed to determine whether interventions designed to enhance physicians’ exploration patients’ experiences of disease and illness improves trust.

Primary care psychology.

Primary Care Psychology examines the essential role that psychology plays in the delivery of primary care. Because psychological and behavioural interventions are natural complements to primary care, psychology is poised to become a full partner in the health profession. This volume brings together the leading researchers, scholars and practitioners to create a thorough and integrated manual about the major topics in primary care psychology. Chapters provide detailed descriptions of procedures that successfully implement theory, practical analysis of clinical and research implications, comprehensive discussions about the provision of care within special populations, critical examinations of the effect that health policy has on practice and resource allocation, and helpful illustrations and case studies.

Competencies for psychology practice in primary care.

This article reports on the outcome of a presidential initiative of 2012 American Psychological Association President Suzanne Bennett Johnson to delineate competencies for primary care (PC) psychology in six broad domains: science, systems, professionalism, relationships, application, and education. Essential knowledge, skills, and attitudes are described for each PC psychology competency. Two behavioral examples are provided to illustrate each competency. Clinical vignettes demonstrate the competencies in action. Delineation of these competencies is intended to inform education, practice, and research in PC psychology and efforts to further develop team-based competencies in PC.

Factors distinguishing families of Patients with Psychogenic seizures from families of Patients with epilepsy

Summary: Purpose: Psychogenic seizures (PS) (emotionally based nonelectrical seizures) have been explained by psychodynamics and trauma. However, the family health literature suggests that somatization, of which psychogenic seizures are a form, may run in families and be determined by family patterns of response to distress. This study compared families of patients with PS and those of patients with epilepsy on variables of distress (anxiety and depression) and somatization.

THE DEVELOPMENT OF JOINT PRINCIPLES: INTEGRATING BEHAVIORAL HEALTH CARE INTO THE PATIENT-CENTERED MEDICAL HOME

The world of primary care was galvanized in 2007 by the publication of the Joint Principles of The Patient-Centered Medical Home (PCMH) that spells out the fundamental features of a primary health care setting in which a team of clinicians offers accessible first-contact primary care.[1][1] This

Medical family therapy with couples facing infertility

Abstract “Medical family therapy” is an approach to psychotherapy with patients and families experiencing a medical illness or disability such as infertility. It assumes that no biomedical event occurs without psychosocial repercussions, and that no psychosocial event occurs without some biological marker. Medical family therapy interweaves the biomedical and the psychosocial by utilizing a biopsychosocial/systems theory, with collaboration between medical providers and family therapists as a centerpiece of the approach. This paper illustrates medical family therapy with couples experiencing infertility and facing the challenges of infertility treatment. Strategies are described that enhance the patients sense of agency and the familys sense of communion during what tends to be a lengthy medical crisis.

Joint principles: integrating behavioral health care into the patient-centered medical home.

The Patient-centered Medical Home (PCMH) is an innovative, improved, and evolving approach to providing primary care that has gained broad acceptance in the United States. The Joint Principles of the PCMH, formulated and endorsed in February 2007, are sound and describe the ideal toward which we

Physician Responses to Ambiguous Patient Symptoms

AbstractOBJECTIVE: To examine how primary care physicians respond to ambiguous patient symptom presentations. DESIGN: Observational study, using thematic analysis within a large cross-sectional study employing standardized patients (SPs), to describe physician responses to ambiguous patient symptoms and patterns of physician-patient interaction. SETTING: Community-based primary care offices within a metropolitan area. PARTICIPANTS: Twenty-three primary care physicians (internists and family physicians). METHOD: Participating physicians had 2 unannounced SP visits randomly inserted into their daily practice schedules and the visits were audiotaped and transcribed. A coding system focusing on physician responses to concerned patients presenting with ambiguous symptoms was developed through an inductive process. Thematic analyses were then applied to coded data. RESULTS: Physicians’ responses to ambiguous symptoms were categorized into 2 primary patterns: high partnering (HP) and usual care (UC). HP was characterized by greater responsiveness to patients’ expression of concern, positivity, sensitivity to patients’ clues about life circumstances, greater acknowledgment of symptom ambiguity, and solicitation of patients’ perspectives on their problems. UC was characterized by denial of ambiguity and less inclusion of patients’ perspectives on their symptoms. Neither HP physicians nor UC physicians actively included patients in treatment planning. CONCLUSIONS: Primary care physicians respond to ambiguity by either ignoring the ambiguity and becoming more directive (UC) or, less often, by acknowledging the ambiguity and attempting to explore symptoms and patient concerns in more detail (HP). Future areas of study could address whether physicians can learn HP behaviors and whether HP behaviors positively affect health outcomes.

An introduction to primary care and psychology.

The health care system in the United States has been less effective and more expensive than it needs to be, but the organizational and political will to address these shortcomings is beginning to emerge. These changes are particularly noticeable in primary care, at the heart of an improved health care system. The value of primary care turns on its comprehensiveness, which means that behavioral health care-health behavior change, mental health care, management of psychological symptoms and psychosocial distress, and attention to substance abuse-must be woven into the fabric of primary care practice. This integration is beginning to happen as psychologists and other behavioral health clinicians are incorporated as essential team members in the patient-centered medical home and other emerging models of primary care. This article introduces psychologists to the fundamental changes taking place in primary care and to the various roles that psychologists can play in the new health care system. We describe the extensive breadth and diversity of primary care by age, sex, setting, and type of clinical problem and the implications of this variety for the psychologists role. This description is not simply a clinical exercise: Transformation of the primary care system also has policy, educational, and research dimensions. We describe how psychologists are essential to these functions as well.

Recommendations for education and training in primary care psychology.

American Psychological Association Publications +The development of this curriculum was funded in 1999 and 2000 by an Interdivisional Grant from the American Psychological Association.