Collaborative Medicine Case Studies: Evidence in Practice

This book is an attempt to demonstrate, through clinical cases from the authors’ experience, that collaboration between behavioral-health clinicians and medical treaters is not only possible, from clinical, financial, and administrative perspectives, it actually leads to improved outcomes. The text comprises over 30 cases that take place in a variety of healthcare settings, demonstrating both the pitfalls of noncollaborative care and the success that can occur when behavioral and medical healthcare providers collaborate in a variety of ways. The book is divided into several sections, with cases highlighting organizational issues along with focused topics in primary care, women’s health, specialty medical care, patients with chronic medical illness, psychiatric disorders in primary care, and pain. The chapters are co-written by the psychologists, physicians, behavioral-health clinicians, and other treaters who provided the multispecialty care to the patients whose cases are discussed. The book begins with a chapter by the editors titled “Primary Care Is the De Facto Mental Health System,” which reviews the data illustrating that most patients with mental illness present to nonpsychiatric/primary-care settings for treatment of medical complaints that may be complicated (or even caused) by their psychological conditions. The authors further note that the current primary medical care system bears the cost for these untreated and undertreated diagnoses. It is in this chapter that the editors frame their message: that the most effective treatment setting is a medical/psychological collaborative-care model in primary-care practice—calling this “the holy grail of medicine.” The following chapter elucidates “The Three-World View” that is referred to in nearly all of the subsequent chapters as a model describing how healthcare organizations operate simultaneously in the clinical, financial, and operational worlds. The multitude of cases that follow are generally quite readable and clear, although somewhat repetitive of the core message. They take place in diverse geographic and treatment settings with a broad variety of payor systems, providing a large variety of examples of systems in which collaboration was effective. The treatment settings described include staff model HMOs, emergency departments, community health centers in rural settings, multidisciplinary pain clinics in urban academic centers, and others. While demonstrating the clear clinical benefit of communication, treatment planning, and professional respect among treaters of a single patient, each case also demonstrates the practical, financial, and administrative challenges encountered in contemporary medical systems. Perhaps the most encouraging aspect of the text is the assortment of settings in which collaboration has worked to improve outcome, allowing for a more reasonable and measured use of resources, decreases in distress and physical symptoms, and lessened strain on an overtaxed healthcare system. Overall, this book will be most helpful to primary-care physicians and healthcare administrators; in particular, those who are finding it challenging to access mental health treatment for their patients or who are interested in optimizing collaboration in their practices. For most psychiatrists, especially for those who practice C–L psychiatry, the basic message (that interdisciplinary collaboration involving communication, respect, and a treatment plan that is understood and accepted by all involved) is likely a matter of course. I would recommend this book to any clinician who treats patients with psychiatric and medical comorbidity and is attempting to create a collaborative practice. This book is also useful for trainees who are attempting to understand the pitfalls and challenges associated with practice outside of academic medical centers, where collaborative connections are likely less established and so require the thoughtful approaches outlined in these cases.