Physical illness caused by psychosocial stress is a clinical dilemma that was known to Hippocrates nearly 2500 years ago. We still don’t have a good solution. Medical clinicians aren’t trained to ask about people’s lives and connect what they find with symptoms. Mental health clinicians don’t see too many patients whose main concern is pain or other body symptoms. But I’m optimistic that in the 21st century will see growing use of good solutions.
I’ve presented my lecture on stress illness to many medical clinicians, and read their evaluations of it, and there is a willingness to do at least a screening form of the Stress History (see other posts on this topic by clicking on the ‘Stress History’ tag below). When they uncover psychosocial issues, however, they don’t feel qualified to go further and will want a mental health clinician (MHC) to step in. This causes two problems. First, the MHC is usually located elsewhere which means another appointment to be kept. Second, there is a stigma in being referred to an MHC, particularly when the patient’s concern is in the body. Medical clinicians find it difficult to suggest these referrals and patients find it difficult to accept them.
My proposed solution for this is to teach MHCs to offer a Stress Check-Up as part of their service. This consists of obtaining a detailed chronology of the patient’s physical symptoms followed by a Stress History, looking for connections between the two. This is a relatively small expansion of an MHC’s existing skill set and, by calling it a Stress Check-Up, much of the stigma is eliminated.
Ideally this service would be offered by an Integrated MHC (IMHC). This individual is co-located with medical staff in the same clinic and able to see patients as part of a single encounter, documenting their findings in the same chart or electronic record. IMHCs are a trend, used in a growing number of HMOs and medical offices and are a focus of the Collaborative Family Healthcare Association at whose conference I lectured last Fall.
Tomorrow I will spend an entire day teaching a roomful of MHCs how to do a Stress Check-Up. I will let my readers know how it goes.
Tags: Blind Spot, Hippocrates, Mind-Body Problem, Stress History
