Perspective on Practice

Let's look at what we psychologists bring to the health-care team, a central focus of emerging health-care system reform proposals. We are uniquely positioned to assume a greater role in managing both health and disease. We know how to assist patients with acute and chronic disease by applying psychological principles to lifestyle and health risk factors. Psychologists emphasize prevention and partner with patients in a relationship that encourages personal responsibility and builds resilience. Our research and critical thinking skills help us assist patients in evaluating and selecting among treatment options and in complying with complex and difficult treatment regimens. We also can co-manage treatment of the patient's psychological disorders.

Psychologists' strong research background, a unique qualification among health-care professionals, prepares us to play key roles in the design, implementation and evaluation of prevention and intervention programs at the individual, family, system and community levels.

We serve many populations in a variety of settings. For example, more than 7,000 federally qualified health centers serve 16.1 million patients who make 63.2 million visits annually. Thirty-nine percent of patients in these health centers are uninsured, and 35 percent are covered by Medicaid. More than half (53 percent) of centers are located in rural areas. Working in federally qualified health centers offers an opportunity for psychologists with an interest in both physical and mental health care to make a real difference in the quality of life of the poor and marginalized.

We have eliminated many causes of acute diseases but have achieved longer lives plagued with chronic ones. Psychologists can have a huge impact on patient outcomes and cost savings by helping to prevent and treat chronic disease. More than 40 percent of U.S. citizens have one or more chronic conditions. Almost two-thirds of health-care spending growth is due to our worsening health habits, particularly the endemic rise in obesity. Individuals with chronic conditions require lifelong attention to manage symptoms and prevent complications and co-morbidities. Prevention is the key to having a healthy and productive work force.

Psychologists have a unique role to play in the prevention and management of chronic diseases. Psychologists have the diagnostic skills to get quickly to the root of the patient's resistance to adhering to treatment—which may be emotional difficulties, personality problems, substance abuse issues or longstanding exposure to trauma. We understand the interpersonal barriers to behavior change and are skilled at motivational interviewing and other psychological interventions. Psychologists understand family systems and the influence of other family members on the patient's choices that maintain unhealthy behaviors. We can impact these systems. We also understand environmental determinants of behavior and can design interventions to modify them.

Many of the treatment techniques and interventions widely used by other health-care professions originated with psychology, including pain management techniques, cognitive-behavioral therapy, smoking cessation strategies, treatment of eating disorders, pre- and post-surgical interventions, and obesity treatment, to name just a few. Our interventions can prevent unnecessary disability and improve the quality of life for individuals and their families.

We have done such a good job of giving our knowledge away that many do not recognize psychologists as the originators of these interventions. And many do not realize that we are the best at applying them! Psychologists are the leading experts in changing the unhealthy behaviors of individuals, families and systems. We have the skills to improve quality of life and at the same time dramatically reduce costs in our health-care system. Psychologists, indeed, bring a unique and valuable set of skills to the health-care arena.

This is the second of two columns adapted from Dr. Nordal's opening address at the March 2009 State Leadership Conference. The first column appeared in the May Monitor.