Family Stress Clinic
Our philosophy has always been that psychosocial issues make up a very large and very interesting part of Family Medicine, and that failure to teach residents some useful skills for dealing with those is irresponsible. We do not expect family doctors to become therapists, but we want them to have a great deal of comfort identifying, dealing with and helping patients resolve those issues, either by brief treatment or referral.
The Family Stress Clinic is a vital and well-integrated part of the Department. It is physically within the Primary Care Center. It consists of a large interviewing room, with comfortable couches and chairs, a play area and a toy shelf for kids; a large observation room where 5 or 6 people can watch comfortably at any one time; and a separate administrative office. The interviewing room includes a one-way mirror and a built-in video camera. Many people express surprise that patients don't have a hard time with these unusual features, but they don't. We deal with them right up front, and patients are comfortable with the idea that there is a team involved in their care.
The FSC is in session 2 or 3 half-days per week. It is staffed by Dr. Claudia Allen, Dr. Tim Siedlecki, two psychology interns with special training, and a 2nd year resident. Between the five of us we will see anywhere from 3 to 7 cases in a half day, with at least one being seen behind the mirror at all times. This allows a discussion of both the problems the patient/family brings and the choices the therapist has as the session unfolds. We see individuals, couples and families, with a wide variety of problems. It is possible to have 2nd year residents see quite complex and challenging cases from the start because of the back-up provided by the mirror and the immediate help available. Therefore, a resident is either treating or watching the treatment of at least three cases per half day. It is an efficient and exciting way to expand your skill with challenging patients.
Many of our clients come from the Primary Care Center, as well as other parts of the hospital (it is a well-known service around the hospital, and a popular referral by other Departments), but also from outside the University. We have maintained a sliding fee scale over the years, so we never have to exclude anyone on financial grounds. The only patients we turn down are those whom a Family Doctor would not usually encounter or attempt to work with in a counseling relationship: the severely mentally ill, complex syndromes that require specialized care, etc. The philosophy of the FSC is that you will encounter these problems in your practice; now is the time to gain experience at understanding them and what can be done about them. The more comfortable you are with them, the more you can help them and the less they will trouble you. Our graduates frequently cite the FSC as a very memorable and important aspect of their training.
Collaborative Care is catching on around the country as medicine becomes more realistic about the importance of dealing with social and psychological problems as part of good medical care, instead of trying to practice around them. Collaborative Care means that a behavioralist accompanies, or is on call for, a physician as she sees her patients. In this way the care of the three arenas, body mind and spirit, can be integrated immediately, in the presence of, and with the cooperation of the patient. This allows a much greater level of satisfaction for both doctor and patient. It allows us to deal directly and effectively with such issues as substance abuse, family conflict, depression and anxiety, noncompliance with medicines, domestic violence and child abuse, parenting problems and a whole host of others. It means that the physician can enlist the aid of a behavioralist, and can move on to other patients without abandoning the psychosocial inquiry part way. Collaborative Care tends to improve our quality of care, our satisfaction with care, and patients' satisfaction with care (though these findings are only anecdotal so far. Research into these questions is in the planning stages.)The Curriculum in Healing is an ongoing undertaking by Dr. Claudia Allen and her team into the vital question, 'What is healing, and how do we teach it?' One might say that no question is more relevant to medicine, since many people go into medicine, and family medicine in particular, precisely out of a desire to be a healer. Yet medicine is getting to be more business-like, and more concerned with time and productivity all the time - and the art of healing is getting lost. Our entire department is committed to the idea of training healers as well as solid practitioners of scientific medicine. The Curriculum in Healing is one aspect of that commitment. We are in the process of delineating the issues that must be covered to teach healing, and the ways in which they can best be taught. Residents get major exposure to this work in both the first and second years. It also figures prominently in other teaching formats: Behavioral Rounds (weekly), Grand Rounds, Inpatient Rounds, and Family Medicine Chart Reviews (3-4 per year per resident). The Healing Curriculum informs all of our offerings in the Behavioral Science arena.