Learning to care for mental health
(Hint: It helps to have 15 like-minded colleagues!)
I believe many physicians in primary care are troubled practicing in the current healthcare environment. Regardless of what they earn, many feel they are too busy and don’t have time to adequately listen to the concerns of their patients and their families.
A recent article in the Boston Globe titled “The precarious future of primary care” echoed those sentiments.
In contrast, I have spent a lifetime finding ways of doing good for others, earning a reasonable living, and loving my work as a pediatrician, so I feel very differently. I want to be helpful for my colleagues in primary care.
I grew up in a troubled family with physical and emotional problems. When I was 4 years old, my father, having Crohn’s disease, needed to have much of his small intestine removed. He expected to die every year thereafter, but didn’t until years later—from Alzheimer’s disease. Family members were depressed because of his illness and chronic disability.
In medical school, I chose to be a pediatrician. I became motivated to learn about mental illness in families, becoming a solo practitioner with that focus. I became competent doing so and would have continued this kind of practice. However, 2 experiences intervened.
In 1995, I participated in the Bright Futures program. It provided time for me to learn more about understanding why families develop emotional problems. In 1998, I became aware of the problem of domestic violence, and 2 years later, with a colleague, I wrote an educational guide for pediatricians.
I developed an educational website, downloading the domestic violence guide as well as other topics relating to emotional problems of families. One of our supporters encouraged me to develop a training program for pediatricians based upon my practice experience. I did so but without long-range plans. The first 2 training programs were somewhat successful.
I decided to pull together everything I had learned during my years of practice as well as my experience teaching others how to become similarly competent, but I still had a problem. Even after 2 programs I had no clear vision how to proceed. Although I worked closely with colleagues, for some reason I chose to lead our program without being particularly dependent upon others for advice.
At the same time, however, I developed a professional relationship with a parenting educator. We met on a professional LISTSERV, but did not meet in person for 2 years. We shared much information about our respective histories. One day, we were given the opportunity to discuss our collaborative process at a national mental health meeting. I had never been so open before. Learning to depend, but appropriately, upon a new colleague helped me become a better role model for those I trained. I began to realize that our program of training pediatricians was developing a unique way of integrating mental health with primary care. I ended up modifying and improving our program.