“Take care of your body: It’s the only place you have to live.”
— Jim Rohn
My brother is a cardiologist. He fixes people with broken hearts. When our career paths became clear, our mother remarked, "Boys, you know, you both heal hearts, but you do it from two very different points of view." Those different points of view are narrowing. Our health-care system is moving toward an integrated, team-based model, where cardiologists may work side-by-side with mental health professionals.
Why? Perhaps most important is that the notion that physical health is separate from mental health has been undeniably debunked. It's clear that many of the prevalent causes of death and disease are caused by behavioral and environmental factors. To ignore the impact of diet and exercise, to ignore smoking and substance abuse, and to minimize health disparities due to socioeconomic status is to be ill-informed. In addition, the changing U.S. demographics highlight the need for a more culturally sensitive, flexible and integrative approach to health care. Research suggests that 70 percent of primary-care visits stem from psychosocial factors. We also know that chronic health conditions, such as diabetes, substance abuse, asthma, obesity and cardiovascular disease, require behavioral health interventions for best outcomes (New England Journal of Medicineopens in new window, 2010). Quality of life and, not surprisingly, the cost of caring for someone who has both a chronic illness and depression can be twice the cost of caring for a patient with chronic illness. This reason alone suggests that integrating mental health care into primary care would be fruitful economically and will create a healthier society.
Even the venerable Medical College Aptitude Test (MCAT) recognizes the importance of behavior in health. The 2015 MCAT now includes a section on psychological, social and biological foundations of behavior. In the description of the new MCAT, the Association of American Medical Colleges emphasizes that individual and social processes that influence human behavior, including attitude and behavior change, demographic characteristics, social inequality, social interactions and cultural identity, are important determinants of health.
There is also an increasing realization based on psychological research indicating that the relationship between the health-care provider and the patient is necessary for good health outcomes. Psychologists have known for decades that patients bring fear, anxiety and limited knowledge about what ails them to our offices and to their physician's offices. Data from John C. Norcross, PhD, and Bruce Wampold, PhD, (2011) finds that the therapy relationship accounts for why clients improve — or fail to improve — at least as much as the treatment itself. Regrettably, due to today's focus on lowering costs while increasing productivity, compassionate, humane and supportive interactions are often replaced with time-limited, problem-focused treatments. With the increased use of technology, the computer often becomes the barrier between the provider and the patient. Listening has become a lost art. While "telehealth," often employing biosensors and smartphone apps, can play a role in health maintenance and health monitoring, the relationship between the patient and the provider remains paramount to a whole-person approach to health care.
The good news is that the lost art of the empathetic "bedside manner" championed by William Osler, MD, in the last century, is now being reintroduced in medical school curricula and residency training programs as critical variables in health. And most important, psychologists add tremendous value to integrated care, through assessment, psychotherapy, behavior change and more.
In addition, the Affordable Care Act provides a window for psychological research and evidence-based practice to move toward integrated care for interested psychologists. Mental health care and substance abuse treatment are explicitly covered as "essential benefits" under the Affordable Care Act. New payment models, including patient-centered health-care homes, and accountable care organizations, all based on treatment outcome data, are being implemented. Unfortunately, these systems are still experimental and not yet fully defined, and that uncertainty has created anxiety for some psychologists. However, for those who can embrace change and tolerate ambiguity, there are ample opportunities for psychologists to participate in this new model of health care.
Maybe my brother and I will be mending broken hearts together soon.