My Lessons Learned In Integrated Primary Care by Lauren DeCaporale-Ryan, PhD

We’ve all been asked the question, “Where do you see yourself in five years?” Though I knew I would prefer to work in a medical setting, I never would have guessed that I would spend most of my professional time in departments of medicine and surgery.

Working in such venues didn’t happen over night. It required continued learning, training, and time. The process hasn’t always been easy: it’s full of challenges and uncertainties. But then, there are the rewards. You begin to identify moments of success when you impact patient care, learn the art of curbside communication, or help someone in medicine recognize how you can be of help.

Your role as a psychologist in a medical setting can (and in my opinion, should be!) more than direct patient care. You have the opportunity to teach physicians, empower families, and improve team functioning.

So how do you get to do this work? What does it look like? Here were my 4 key learning points (plus a few side notes) during my own training that I continue to remind myself of routinely.

1. NEVER work in a bubble. The whole purpose of integration is avoiding working in silos. Get yourself out there, leave your desk, and talk to people. Learn about the physicians and staff you are working with, not just about their patient experiences, but about their likes and dislikes (personally and professionally).

Conversation will build relationships and relationships will make you better at your job. In knowing all of the key players, you can start to support them in different ways: you may understand why people butt heads in meetings sometimes, or you may understand the things that trigger their own anxieties in patient care. Leaving your desk makes you more informed and more approachable.  You learn how to help those who work around you. And you can learn a lot about how a workplace and its team(s) function.

At one time, I had an office that was in an administrative section of the clinic. I started to notice how removed I felt. I didn’t know what was happening in the lives of our secretaries, I didn’t get to quickly collaborate with someone passing down the hall, and people didn’t know where to find me. I intentionally started walking around the building: I’d purposefully ‘bump’ into someone. And I’d do this at least once a day. Now when I don’t do this, people comment about my absence.

2. When you are walking around and chatting, always remember to be brief. Clinicians in medicine are accustomed to 15-minute visits (which most estimates suggests somewhere between 4 and 7 minutes face-to-face with patients). Pick up your pace when you can, figuring out how to get your message across concisely, effectively and efficiently. If you don’t, people will stop listening to you (and eventually stop valuing your input).

And when you need to talk about a patient or other clinical issue, always remember that it might not be convenient to the other party. Every time I need to approach a physician for collaborative dialogue, I always ask the question, “Do you have 3 minutes?” (Or 30 seconds, 5 minutes, whatever approximation seems to be the best fit. Acknowledge that you value their time.)

3. Remember that you are an expert in mental/behavioral health issues and that is why you are there. Then, pay attention to what you don’t know. Take time to learn who the other experts in your office are. Shadow physicians, nurse practitioners, residents, pharmacists, care managers, nurses, social workers.

Understand what each of these team players does and brings to patient care. Honor their talents. Let them help you. Determine how you can best help them. Recognize that this means many many things: consultation, warm hand-offs, brief screening and assessment, therapeutic interventions, team consultation.

Be Flexible. You will be asked to do many things. Recognize what it means to be a psychologist in these venues: you have the training and knowledge to accommodate multiple modalities of assessment and intervention. See patients where they need to be seen, meet physicians where they need to meet.

4. Always remember that your needs are just as important as those of the other clinicians and staff you are working with.
A physician once told me that I needed to honor and respect my needs just as much as I would others’. Obvious right? But sometimes, we lose sight of this because we’re trying to take care of other people, even those we work with. So in my early training, I tried to honor and respect most requests made of me. But some of them just didn’t sit right: “don’t discharge her, I’d really rather not be alone in her care,” “I think his diagnosis should be different, why don’t you just change it to this instead?”

You’re going to encounter all sorts of requests, some you might agree with, some may leave you feeling unsettled. Set limits that honor your expertise. Tell other clinicians how they can help you (within reason of course). Explain your decision making when you have to so that others not only understand, but then support, your rationale. And talk about your needs when they might conflict with others’: talk to other clinicians (of your and other professions), and seek supervision and mentorship.

Integration takes time and practice: allow yourself both of these things.
Though many are doing this work, some systems are just learning it. It will take time to make change, time to learn how to work with new people and new professions. Find good role models and mentors who have done this work before: you will learn so much from watching them in action. And whatever you do, be creative and have fun!  Everyday is different, which makes integration and collaboration incredibly rewarding and will keep you on your toes!

Author,

Lauren N. DeCaporale-Ryan, PhD
Licensed Clinical Psychologist
Rochester, NY, University of Rochester Faculty Medical Group
Senior Instructor, University of Rochester Medical Center, Departments of Psychiatry (Psychology), Medicine, & Surgery
Member, American Psychological Association
Member, Board of Directors, Early Career Representative, Collaborative Family Health Care Association
Member, Gerontological Association of America