The Register Report, Fall 2006: Competencies Clinical Competencies for Practicing in Primary Health Care by: James R. Bray, Ph.D. Return to Table of Contents

Primary care psychology is a growing area of practice. There are increased pressures on primary care physicians (PCPs) to diagnosis and treat a broad spectrum of health problems that include both biomedical and psychosocial concerns. PCPs treat over 60% of all mental health problems in the United States, without assistance from psychologists. We are frequently not part of the primary health care system, even though psychologists are often the most highly trained mental health and substance abuse professionals functioning in these communities. Our isolation from primary care is often due to a lack of training and competency to work in this arena. This article will briefly review some of the competencies needed to successfully practice in primary care. For a more complete discussion of these issues see Primary Care Psychology (Frank, McDaniel, Bray & Heldring, 2004; especially chapter by McDaniel, Hargrove, Belar, Schroeder & Freeman), Handbook of Primary Care Psychology (Haas, 2004) and Bray (2004). PCPs need help with patients who suffer from a broad range of behavioral and mental health problems and assistance with chronic health problems, such as cardio-vascular disease, diabetes, etc. Psychologists can provide important diagnostic services, information about use of psychotropic medications and psychotherapies for treatment (Bray, 2004). Successful collaboration with PCPs needs to be a win-win business relationship for everyone.

PCPs seek to solve a patient care problem, obtain feedback and information about their patients’ status and progress, receive referrals back from the psychologist and reduce their hassle with patient care. Psychologists can provide important diagnostic information about the patient, recommend additional treatment options, provide information about progress of psychotropic medications and help increase patient compliance and satisfaction (Haley et al., 1998).

It is important to remember that PCPs are considered generalists and work with all kinds of patients (undifferentiated symptom patterns). Likewise, to work most effectively as a psychologist in primary care it is important to function as a “generalist” behavioral health provider who is able to effectively collaborate with medical practitioners. Training in family systems or contextual theory is particularly useful because it facilitates the behavioral health provider’s ability to take a “broader” viewpoint and negotiate roles and relationships with both physicians and patients.

1. Basic knowledge of primary care medical practice. Primary care practice is very different from psychological practice. These differences include the way the office is organized, staffed, patients are handled, and expectations for referral and collaboration. It is imperative to successfully work in primary care that the psychologist understands how PCPs practice and is willing to adapt and accommodate to primary care practice styles (see Driscoll & McCabe, 2004 for an example of a private practice).

Primary care practice relies on biomedical research, technological solutions, hierarchical relationships, strong sense of personal responsibility for patient outcomes, emphasis on clinical methods and experience, and often specialized, pragmatic thinking. The PCPs job is to find an answer for and fix the patient’s problem. In other words, the primary goals are to cure disease and alleviate symptoms. If the PCP cannot attain these goals, the goals become maintenance or restoration of functioning. The adage “just don’t stand there, do something,” aptly describes one modus operandi of physicians (Bray & Rogers, 1995, 1997).

To gain familiarity with primary care practice, ask to work with a PCP in his/her office. Many PCPs welcome psychologists to practice in their offices either part-time or full-time. In addition, PCPs often have medical students work with them and they will often welcome a psychologist to spend time with them seeing patients. This direct experience provides a quick way to learn about medical practice and to develop a strong relationship with the PCP and their staff. continued

 

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