In Massachusetts, primary care providers (PCPs) receive a failing grade in screening their patients for behavioral health issues despite their aptitude for screening for med/surg issues. This finding comes from Mass. Health Quality Partners (MHQP), a not-for-profit that interviewed 44,000 adult patients, most of whom said that their physicians had not asked them about depression and substance abuse. On a scale in which “fully expressing concerns about patient mental-emotional health” counts for 100 points, the physicians scored an average of 56.
For years, the federal government has been boosting “integrated care” in which PCPs are supposed to lead the way to better levels of overall health. At conferences, in hospital trainings, and in medical schools, PCPs, on the front lines of care, have been identified as the key to bringing about population wellness. Yet the MHQP results show that government and private efforts have not resulted in moving doctors toward taking more responsibility for the mental health of their patients.
This is the first time in its 12-year history that MHQP focused on physicians’ behavioral health screening. It surveyed a total of 65,000 patients as well as 4,000 doctors in 500 medical practices (see report here). MHQP reported that in the past year a few medical practices made an effort to improve their patient care in this area, sometimes by having patients fill out a behavioral health questionnaire which led to productive patient-physician conversations about managing mental-emotional problems. Most medical practices, however, have not bothered to take even this step.
“Obviously, overlooking depression and substance abuse is a concern,” said Barbra Rabson, CEO of MHQP. Beyond speculating that doctors are “not comfortable” with such screenings, or “may not have the training,” she did not know why so many physicians ignore their patients’ behavioral health. The importance of these screenings has been made widely known in professional journals, medical literature, and healthcare conferences, including many podcasts and other easily accessed media. Nor is there any shortage of highly capable clinical social workers willing to consult with physicians and to take referrals for providing the requisite follow-up care.
What is going on here? Why is so much not going on? Presumably this problem of physician indifference exists beyond Massachusetts boundaries. What is happening in your area? Do PCPs ask their patients about their mental-emotional wellbeing, and collaborate with clinical social workers?
The federal government pumps billions of dollars into medical research and education and has invested heavily in population wellness—mental and physical—and in integrated care as the best way to achieve it. No one refutes its importance. Why are doctors and medical practices so resistant? And what will it take to make them change?
image via thewaitingroommagazine.com.