Incorporating mental health into clinician training programs

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It often strikes me after a long day at the office how much time I spend counseling my patients.  I'm not referring to health-related advice, but rather true mental-health counseling.  What disturbs me is that I often feel ill equipped to truly provide the kind of help that my patients are seeking. 

My graduate education was comprehensive and truly prepared me to provide excellent care to women throughout the lifespan.  But I often wish that the program placed more emphasis on the psychological issues that are so much a part of my daily practice. 

It is a rare day that I do not have at least one patient cry during her visit with me.  Some of the issues have little to do with women's health, but are life issues that are causing stress.  During visits, patients confide myriad problems. They confide in me about their failing marriages, job losses, sick children or parents and chronic health conditions, just to name a few.    

Specific women's health issues such as unintended pregnancy, infertility, pregnancy loss, newly diagnosed STDs, lack of libido, menopause and intimate partner violence each carry psychological implications that must be addressed. These problems often require far more time than is allotted for a scheduled office visit. 

Depression and anxiety in women throughout the lifespan is increasingly common, and patients frequently ask me to prescribe an anti-depressant during their annual exam. I feel uncomfortable simply throwing medication at an issue that would benefit from counseling or psychiatric care in conjunction with pharmacologic management. I refer out to mental health providers, but I know that many women don't follow up due to lack of time or money. 

For many of my patients, the “well woman” visit is the only regular contact they have with a health care provider. They look to their midwife to provide not only their Pap smear and breast exam, but also primary and psychological care. 

When I first began practicing, I was surprised by how much of midwifery care is also mental health care and counseling. I'm sure this is true of other health care specialties as well. But how many educational programs put enough focus on building the skills we need to provide this essential care, beyond pharmacologic management?

I feel an entire class within each specialty preparation program could easily be devoted to mental health needs throughout the lifespan, as well as fine tuning listening and counseling skills. Both provider and patient would benefit. 

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