“How do I even start the conversation with him; what do I tell him?” Kate shared her concern with Roger, the primary care physician, leading the Integrated Care Initiative, at the HOPE clinic. “Kate, you are posing the right questions, and you are not alone. Let’s carve out some regular time, going forward, to help answer this and many other questions that you may have.” Roger responded to Kate in a thoughtful way, always with a smile.
Kate was alluding to Peter, a 57-year-old man, who believed strongly that he was going to die; “There is so much going on with me; so many medications, so many visits to the doctor.” Peter received home health care resident visits from multiple providers, including, nursing care, the care coordinator, and the diabetic educator, in addition to visits from Kate, the social worker. He began sharing medical concerns and complaints with Kate that he was not sharing with the rest of the staff. However Kate was limited in her understanding and ability to best support Peter.
You may have been in similar situations where you felt the type of limitations Kate was experiencing; and, like Kate, you, at times, may have been concerned and frustrated. As Roger told Kate, you, too, are not alone. Below are 5 reasons why it is crucial to learn the basic integrated care skills as a non-medical staff.
Client and Patient Perspective:
1. Comprehensive care for your patients and clients
Those affected with schizophrenia have an average life expectancy, estimated to be 20 years shorter than that of the general population. I have personally found this outcome to be unacceptable, and, as a clinician and advocate, I am sure you find it to be a cause for concern as well. Implementing a comprehensive care approach for patients and clients will require channeling this concern and frustration into productive action. Part of the solution to this crisis lies in prevention and early intervention. You will be able to assist your patients and clients with this solution-based approach, as you learn the basic skills of integrated care.
2. Leverage of the therapeutic relationship
Therapeutic alliance is a crucial ingredient in effective clinical care, and this relationship often grows stronger with time. When compared to the medical staff, non-medical staffs tend to spend much more time with the patients and clients, who increasingly trust them and feel comfortable with telling them things pertaining to their physical health. And yet, at times, I hear patients telling non-medical staff, “You are not a doctor. I don’t need to talk to you about that.” Nonetheless, I can assure you that this sentiment tends to go away as the relationship strengthens.
Further, learning the basic integrated care skills will help you, as a non-medical clinician, feel empowered and at ease, comfortable when asking about physical health needs. You will also have the confidence needed to answer some basic questions that your patients and clients may have; this, in turn, will generate positive reinforcement. Both you and your patient and client will, therefore, be able to leverage the relationship, and you will eventually help them achieve comprehensive care.
3. Better advocacy for your patients and clients
Because health needs are not just limited to mental health, but also include physical health needs, you will be more empowered and better able to efficiently and effectively function as an advocate, especially with the tools for basic integrated care. Kate was concerned, because she did not know how to respond to Peter, nor did she know how to explain Peter’s concerns to the medical staff. With time and the right training, this feeling would expectedly dissipate, as Kate would find the confidence and skill for effective advocacy for Peter and several of her other patients and clients.
4. Career gratification
You may well know the factors that either promote or obstruct career gratification. Certainly, feeling that you are not doing anything for your patients or clients or that you are unable to assist or even know the right steps required for progress are a few examples of how career gratification can suffer obstruction. As indicated, these subjective feelings tend to disappear over time, with the right training and skill development. For example, Kate would be able to sit and listen to Peter’s concerns, know the right questions to ask, know the right things to report to her medical colleagues, and know how best to urge them to take the appropriate action. Kate would also feel more of a sense of gratification, for she would be taking steps to help Peter, meeting him at his point of need.
Client and Clinician and Agency and System Perspective:
5. Health literacy
Knowledge appropriated in the right way can help provide a sense of empowerment, and when it comes to health, not knowing can have devastating consequences for our patients and clients, for us as clinicians and advocates, for our agencies, and for the system overall. In addition, health literacy enhances communication among staff; it helps eliminate fragmented care, and it minimizes medical and health related errors overall. As Kate continued to work with Roger, her health literacy slowly increased, and, as she started to engage Peter, Kate found more effective ways to communicate with her medical colleagues. Listen to the way she summarized her overall experience, “My career has never been the same.”
“How do I even start the conversation with him; what do I tell him?” Kate was concerned and rightly so. She wanted to do more to help in the best way she could, but she did not even know where to start. With Roger’s help, Kate has been able to learn the necessities of basic integrated care, required to take her career and her clinical and advocacy skills to the next level. She has been able to put a comprehensive care approach into practice, learning how to communicate medical related information and achieve a sense of satisfaction for health literacy. This has enhanced her advocacy skillset and supported career gratification.
Health care no longer only happens within the confines of the four walls of the office. A lot of it occurs in the “field,” in the community, especially since certain patients and clients barely make it to a medical clinic. Health care is neither limited to just mental health or physical health needs; it involves a comprehensive health approach to integrated care. The basic skills in integrated care are required for all of us, if we are to make a difference in the lives of our patients and clients.
I hope this article stirs your motivation to learn more about integrated care skills. There are many reasons to consider the importance of understanding integrated care: the perspective of our clients and patients, our perspectives as clinicians and advocates, and our agency and system perspectives.
Please share your thoughts and experiences; share this article with others, and let us continue to strive to make a difference in the lives of others, while ensuring we take care of ourselves, prevent burn out, and obtain career gratification.
Your friend and colleague,
Dr. Sidor is a quadruple board certified psychiatrist, with board certification in general adult, child and adolescent, forensic, and addiction, psychiatry. He has former experience as a primary care physician and additional training in public/community psychiatry, psychopharmacology, cognitive behavioral therapy and psychodynamic psychotherapy. He has clinical, teaching, supervision, mentorship, and management skills. He also has experience in public speaking, leadership, and research, in addition to a passion for program development and project management. His overall goal is to empower all health care professionals throughout the United States and globally, towards ensuring the continuity of excellent patient care, while balancing the need to take care of themselves. Dr. Sidor is the main instructor for the SWEET Institute, and he is currently Assistant Professor of Psychiatry at Columbia University. He is also the Medical Director and Chief Medical Officer for CASES (Center for Alternative Sentencing and employment Services), and he speaks and writes fluently in six (6) languages—French, English, Spanish, Portuguese, Creole and Italian.
Committee on Quality of Health Care in America IoM. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington: National Academy Press, 2001.
Plochg T, Klazinga NS. Community-based integrated care: myth or must? Int J Qual Health Care 2002; 14: 91–101.
Glouberman S, Mintzberg H. Managing the care of health and the cure of disease—Part I: Differentiation. Health Care Manage Rev 2001; 26: 56–69.
Glouberman S, Mintzberg H. Managing the care of health and the cure of disease—Part II: Integration. Health Care Manage Rev 2001; 26: 70–84.
Grol R. Between evidence-based practice and total quality management: the implementation of cost-effective care. Int J Qual Health Care 2000; 12: 297–304.
Villagra V. Strategies to control costs and quality—A focus on outcomes research for disease management. Medical Care 2004; 42: 24–30.
Mur-Veeman I, Hardy B, Steenbergen M, Wistow G. Development of integrated care in England and the Netherlands: managing across public–private boundaries. Health Policy 2003; 65: 227–241.
Philbin EF. Comprehensive multidisciplinary programs for the management of patients with congestive heart failure. J Gen Intern Med 1999; 14: 130–135.
Norris SL, Nichols PJ, Caspersen CJ et al. The effectiveness of disease and case management for people with diabetes. A systematic review. Am J Prev Med 2002; 22 (4 suppl.): 15–38.
Renders CM, Wagner EH. Interventions to improve the management of diabetes mellitus in primary care, outpatient and community settings. Cochrane Library 2002.