Behold! Mind/body medicine

HEALTH CARE

We have seen the future of health care, and it looks like this: In
its most evolved form, there's a mental health worker--psychiatrist,
psychologist, social worker, or marriage and family therapist--in the
doctor's office.

Call it "collaborative family health care." Medical and mental
health professionals share the same offices and staff, they consult and
talk frequently, and they may even see patients together. The point is,
"mental" and "health" are, finally, integrated.

Pipe dream? According to the University of Minnesota's William
Doherty, Ph.D., it's already happening at the largest health maintenance
organization (HMO) in the Twin Cities (Group Health), as well as at a
fertility center, a diabetes center, and primary care settings, such as
offices of internists and obstetricians/gynecologists.

It's more than just a meeting of mind and body. It's cost-effective
provision of health-care services, as well.

"We know that a high proportion of primary care visits are related
to psychosocial problems," says Doherty, professor of family social
science and a prime mover in integrated health care. "Most mental health
patients are seen by primary care physicians, who treat them with
medication."

And while somatic complaints are often the ticket to the doctor for
those who are depressed and anxious, such patients are seldom happy with
whatever a doctor does. "The collaborative model gets everyone closer to
the site of the action," Doherty says.

As it moves away from fee-for-service and toward capitation, or a
fixed amount per patient, health care will definitely require changes in
the way medicine is practiced and delivered. So why not do it in a way
that makes internal, not just institutional, sense?

Paradigm shifts don't come easy. Carrying it off is going to take a
lot on the part of professionals. Just to work in the same sphere,
doctors of the head and doctors of the body must learn to transcend their
"professional ethnicity." They'll have to find a common language.

Earlier this year, at a meeting sponsored by the Johnson
Foundation, some 60 or so forward-thinking representatives of family
medicine, general medicine, pediatrics, psychology, psychiatry, and
family therapy got together to outline opportunities and future
directions for collaborative care.

It's a safe bet that most Americans will welcome dose encounters of
the biopsychosocial kind.

ILLUSTRATION