A Primary Care Psychologist together with the Family Physician: the experience of the Health Psychology School of Rome
Abstract
It is known that at least 50% of the requests that people make to family physicians, behind the proposal of a somatic symptom, express relational/existential distress, often in very early phases, in which the intervention could be short and easy: the doctor, however, is not always in the position to offer an answer, and therefore ends up carrying out analyses and administering drugs whose uselessness he is the first to recognize. A response by referral to a psychologist appears problematic given the difficulty in identifying both the patients to be referred and the appropriate referring methods. Anyhow, the acceptance of the referral by the patient appears unlikely, since contact with a psychologist is still burdened by strong social stigma.
An initiative is then described, implemented by the postgraduate Health Psychology School of the Rome University Sapienza, implying the presence of psychologists in training in the consulting rooms of family physicians, in the usual ambulatory hours, in co-presence with the doctor. This practice has allowed to achieve a holistic and early approach to the distress presented, without the need for a specific request from the patient. In a small number of cases, a more formal clinical approach was proposed and implemented by the psychologist in separate times and spaces. Clinical cases have always been discussed between the two professionals and supervised in meetings at least fortnightly by a member of the School Faculty.
So far the experience, which has lasted for 20 years, has involved 31 psychologists in postgraduate training, for 3 years each, in medical practices in different regions of Italy; it has shown to be entirely feasible, though it requires a certain period of adaptation between the two professional figures. Patients welcomed the presence of the psychologist with great favor and, as expected, spontaneously adopted a much broader approach to their distress. In two cases in which it was possible to obtain the data, there was a significant decrease in pharmaceutical expenditure, respectively by 17 and 14%. An illustrative case shows how the discovery and discussion of a difficult life situation staying behind a somatic symptom not only led to the resolution of the symptom itself, but also facilitated the crossing of an important phase of the life cycle.
