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Despite the astronomical costs of healthcare in the U.S., patient outcomes remain suboptimal. While physicians are well-equipped to help patients address biomedical aspects of illnesses, medical training in psycho-behavioral, non-pharmacological illness management is lacking. Patients who are served in primary care may be especially affected. Primary care functions as the “de facto mental healthcare service”; however specialty referrals are frequently unavailable or poorly pursued, and many patients are either distrustful of or unable to afford pharmacotherapy.
While physicians may acknowledge the role of psychosocial and behavioral factors in etiology and maintenance of multiple conditions, they are ill-prepared to discuss these mechanisms and management strategies (beyond prescriptions and referrals) with their patients. As the symptoms of poorly managed chronic conditions do not improve over time (and periodically flare up), frustrated and scared patients are forced to return to treatment. In turn, physicians who focus exclusively on the biomedical illness aspects order more tests, place more referrals, and prescribe more medications. Unfortunately, these efforts lead to increased financial burden on patients and healthcare systems, and increase risks related to side effect of medications, procedures, and incidental findings, without symptom resolution or reprieve.
Under current economic, social and political pressures, the practice of medicine needs to embrace nonpharmacological interventions grounded in patient-centeredness and increase its focus on contextual and culturally informed care. The ability to address such factors effectively is associated with decreased costs and better care. However, given multiple administrative and clinical demands, any interventions must also be brief and provide physicians and patients with practical and clear steps to facilitate discussion and promote patient engagement with proposed interventions.
This book aims to address the existing gap in physicians’ knowledge and skills by offering clear, practical and concise non-pharmacological interventions for commonly encountered psychiatric and chronic pain conditions, helping patients achieve sustained symptom relief. succinct guidance to physicians with a focus on psychiatric and chronic pain conditions as these require non-pharmacological interventions for sustained symptom improvement.
About the author
Dr. Nataliya Pilipenko, PhD, ABPP
Center for Family and Community Medicine
Columbia University Irving Medical Center/New York Presbyterian Hospital
Vagelos College of Physicians and Surgeons
New York, NY
Dr. Krishna M. Desai, MD, FAAFP, ABOIM
Center for Family and Community Medicine
Columbia University Irving Medical Center/New York Presbyterian Hospital
Center for Neuroinflammatory Disorders and Biobehavioral Medicine in Department of Psychiatry
New York, NY
Summary
Despite the astronomical costs of healthcare in the U.S., patient outcomes remain suboptimal. While physicians are well-equipped to help patients address biomedical aspects of illnesses, medical training in psycho-behavioral, non-pharmacological illness management is lacking. Patients who are served in primary care may be especially affected. Primary care functions as the “de facto mental healthcare service”; however specialty referrals are frequently unavailable or poorly pursued, and many patients are either distrustful of or unable to afford pharmacotherapy.
While physicians may acknowledge the role of psychosocial and behavioral factors in etiology and maintenance of multiple conditions, they are ill-prepared to discuss these mechanisms and management strategies (beyond prescriptions and referrals) with their patients. As the symptoms of poorly managed chronic conditions do not improve over time (and periodically flare up), frustrated and scared patients are forced to return to treatment. In turn, physicians who focus exclusively on the biomedical illness aspects order more tests, place more referrals, and prescribe more medications. Unfortunately, these efforts lead to increased financial burden on patients and healthcare systems, and increase risks related to side effect of medications, procedures, and incidental findings, without symptom resolution or reprieve.
Under current economic, social and political pressures, the practice of medicine needs to embrace nonpharmacological interventions grounded in patient-centeredness and increase its focus on contextual and culturally informed care. The ability to address such factors effectively is associated with decreased costs and better care. However, given multiple administrative and clinical demands, any interventions must also be brief and provide physicians and patients with practical and clear steps to facilitate discussion and promote patient engagement with proposed interventions.
This book aims to address the existing gap in physicians’ knowledge and skills by offering clear, practical and concise non-pharmacological interventions for commonly encountered psychiatric and chronic pain conditions, helping patients achieve sustained symptom relief.
