4 Comments to
Adding Counseling to Doctor Visits

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  1. I know this very off-topic, but as one of the top 50 websites of 2008, why is it you have grammatical errors in your blogs? In the sixth paragraph it says, “The focus of the intervention is address problem behaviors in the person’s life…” It just seems a little unprofessional. Sorry, just a side note.

    As for the article itself, I think it’s a fantastic idea. A lot of times people will be feeling depressed or anxious, and they will convince themselves it is because of some physical situation. People have no problem of convincing themselves that what they think is what they feel. Having someone there to talk to when they see a doctor would not only help them where they need it, but it would give them a little more comfort about the whole situation of going to a psychologist.

  2. I think it’s a great idea too if used with caution. Me being the cynic I am would wonder how many of these counselors would be “ambulance chasers”? For example if someone comes in complaining of migraines and the counselors response would be “uh oh you are anxious…you need years of therapy to work this out.” I think sometimes a patient would be getting a little more than they bargained for…especially if you could just pop a pill at little cost and little effort. But I do agree it is a great service for people who are too shy or feel humiliated asking for help.

  3. Jack, I see your point, but I don’t see this solution becoming “pill popping” or “ambulance chasing.” Dr. Grohol is right, something needs to be done to help those who don’t/won’t/deny.

    I saw my primary care (Internist) yesterday. Last week I received a flier in the mail. It was cute and colorful. I didn’t pay much attention to it. While I was in triage yesterday (pre exam room) I was asked if I received the flier and did I complete the check list and comments and bring it with me. No, I said. I did complete the form will at my appt, but not until my doc was in the room as I had questions about items on the flier. My questions were about the mental health questions on the flier.

    The flier was about just what Dr. Grohol is talking about, but not on the level that a behavioral health professional in-clinic would use. I was a tool that the physician’s office was using to connect with their patients in an effort to help patients take responsibility for their physical AND mental health.

    Having said all of the above, I don’t see my regional medical group bringing in mental or behavorial health counselors…the cost to hire them would be seen as cost prohibitive. But, something does need to be done. And yes, herein lies the problem…cost to the medical group, as well as cost to the insurance company.

    In the paragraph that begins with, “How it works is simple” there is a description of how this would work in a medical clinic setting. It sounds great, and cost is certainly a problem, but how many people who receive this intervention would take it seriously? I only see my Internist maybe quarterly, and this is only because I am diabetic and she needs to check my A1c. So, again I have the question how to convince people to take the advice the counselor provides seriously?

    Dr. Grohol said in his article, “more readily accessible mental health services — people just aren’t that interested.” Is it that they are not interested or that they are fearful that a “mental health” stigma will fall upon them simply because they saw the counselor? Between denial and stigma, how can one get people to be “interested?” Is the mother with the problematic child going to take the advice received from the counselor and tell his/her coworkers and/or family about it. Or will she deny she needed the advice to begin with out of fear that she may be seen as a problem mother?

  4. Just go to Philip Dawdy’s latest posting at http://www.furiousseasons.com and read how PCPs and pediatricians are sizeable prescribers for psychotropics like stimulants and antipsychotics.

    Like this recommendation the above posting is suggesting will not lead to more of this? When will people figure out that this society is more focused on “biochemical imbalances” and “better living through chemistry” to handle these psychological travails that are presented in somatic care offices. The idea of some type of ‘counseling’ at a PCP’s office has some merit, but the adage “the road to hell is paved with good intentions” is the take home message from this at the end of the day. My interpretation of this, not to be demeaning to you, Dr Grohol, is risking the potential to trivialize and dumb down the role of psychological factors to real and perceived medical matters, and patients are not going to make serious strides to work on solving these problems in the multifaceted way they should be directed to seek.

    Come on, am I truly the only one who sees the patient in the PCP’s office at the end of the visit having a script pushed across the desk?

    I recently found Einstein’s quote that echoes here so well: insanity is doing the same thing over and over again and expecting different results.

    And that is the problem: everyone is a bleepin’ mental health care provider until the problem is so immense, leaving the true experienced provider and complicated patient to be showered by the crap hitting the fan!

    Sorry I am again not supportive of one of your posts, but I am a voice of dissent until proven otherwise. I will not be silent after enduring many years of alleged good intentions ignoring the realities of setting limits with those who oversimplify the interventions. This line of reasoning will only take mental health providers further out of the equation, and I am not just talking about psychiatrists. I could be wrong, but then again, I seem to be less pertinent every day as a psychiatrist. Some readers may smile with glee reading that last comment, but are people that preemptive to realize what will happen if psychiatry is deemed irrelevant?

    In the end, it will be the patient who suffers most, being robbed of the opportunity to access the real specialists who embrace responsible mental health care treatment for the problems.

    Hey, isn’t that what health care reform will wind up doing anyway?

    Sleep well.

  5. I don’t know I have seen “mental health” specialists and they pretty much did nothing for me. In fact the best care I get for my severe anxiety is from my internist. He prescribes the right combination of medications and I am happy to say I am doing great because of it. I don’t really care if I have to stay on the meds long term. It is what it is and if this is what is going to give me my life back then so be it.

  6. I don’t know. My Internist does a fine job at helping me control my Panic/Anxiety symptoms. He has me on the perfect combination of medications and I have not had a bout with panic since I started these miracle pills. If I have to take a pill everyday to keep my normal life, I think it’s a small price to pay compared to the alternative.


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