Studies estimate that 35% of patients in primary care practice have psychosocial, not biomedical, problems. Clearly, then, physicians must be grounded in the psychosocial, as well as the biomedical domains, in order to provide optimum care for their patients. The psychosocial domain encompasses 1) a patient-centered, as opposed to purely physician-centered, approach; 2) interviewing skills, including listening, empathy and an awareness of how one's own feelings, biases, responses, etc., affect the doctor-patient relationship; 3) a belief that all illnesses have psychosocial aspects that influence their cause, manifestation, course, and outcome; and 4) the skills to diagnose and treat common psychosocial problems, such as mood and anxiety disorders, somatoform disorders, substance abuse, domestic violence, and non-adherence. The psychosocial domain is complementary to the knowledge, skills, and attitudes of the biomedical domain. Incorporating both domains in clinical practice is the called the biopsychosocial approach, useful not only for patients with mental health problems, but for all patients.
Research shows that physicians who use a biopsychosocial approach to patient care have more satisfied and adherent patients, affect better health outcomes, are more professionally satisfied, and even have fewer malpractice suits! The Psychosocial Curriculum seeks to provide house staff with the knowledge, skills, and attitudes needed to be successful and fulfilled internists. This three-year curriculum includes didactic and experiential components led by internists, psychiatrists and psychologists. The didactic lectures in the ambulatory core curriculum are in the following areas: depressive disorders, anxiety disorders, somatization, post-traumatic stress disorder, obsessive-compulsive disorder, neuropsychiatry, psychosis, movement disorders, psychopharmacology, psychiatric epidemiology, organic brain disease, domestic violence, alcohol abuse, helping patients to change behaviors, dealing with difficult situations, primary care of gay and lesbian patients, helping patients improve adherence and spirituality in medicine.
Experiential components include 1) primary care psychiatry consultation clinic, 2) outpatient substance abuse center, 3) medical interviewing tutorials10, 4) behavioral change counseling consultation clinic, and 5) difficult patient workshop.
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