Keeping patients physically well: A psychiatrist’s ‘CIVIC’ duty
Watch for 5 common medical problems.
Check with patients at each visit to ensure they are following through on their test referrals. If they are not, find out why.
If the patient is procrastinating, try to uncover an underlying cause. If the patient says he or she is pressed for time, ask: “Are you going through stressful life events? Are you afraid the test will hurt or will reveal a serious disease? Did you have this test before? If so, did it make you uncomfortable?
Tell the patent, “I understand your concerns, but this test is important. You need to make it a higher priority.” To work through the patient’s resistance, start by educating him or her about preventable chronic diseases and screening or treatment resources. Then try problem-solving techniques, motivational interviewing, or dissecting cognitive distortions.
Collaboration with a case manager is key when managing an indigent mentally ill patient. Open communication, setting well-defined goals, and a clear understanding of each other’s treatment roles is crucial. Inform the case manager which target tasks, tests, or appointments the patient has agreed to. The case manager can use this information to help the patient navigate the health care system and encourage full participation in care
Finally, build a referral base for indigent and uninsured patients. Look for a nearby internist, gastroenterologist, and OB/GYN who accept uninsured patients.
- U.S. Preventative Services Task Force. Continually updated, evidence-based screening recommendations for a range of medical problems. www.ahrq.gov/clinic/uspstfix.htm.
- U.S. Public Health Service. Clinical practice guideline: treating tobacco use and dependence. www.surgeongeneral.gov/tobacco/treating_tobacco_use.pdf.
- Olanzapine • Zyprexa
- Oxcarbazepine • Trileptal
Dr. Moss recevies research/grant support from the National Institutes of Health and is a speaker for Janssen Pharmaceutica and Pfizer.
Mr. Brammer and Dr. White report no financial relationship with any company whose products are mentioned in this article, or with manufacturers of competing products.
