Psychologists in integrated health care: Geriatrics


>>Tan Nguyen: My name is Dr. Tan>>Patient: Hi, How are you? You can call me
Jerry>>Tan Nguyen: Nice to meet you Jerry>>Aliza Romirowsky: Hi, I’m Aliza>>Richard Zweig: Some people have said that
geriatrics is nothing if not a team enterprise.>>Patient: Well I’ve been having some problems…>>Richard Zweig: Working in a silo doesn’t
work for that older patient. By definition, the problems that they are coming to you with
as a psychologist or that they would come to their physician with>>Patient: and she’s worried that that I’m
forgetful..>>Richard Zweig: are often problems that
have biological and psychological and social determinants.>>Steven Hahn: Jacobi Hospital is in the Bronx.
It’s an amazingly diverse population. We have patients from all over the world. We
run what we call a medicine psychology/geropsychology consultation clinic here at Jacobi and that’s
the training site for the geropsychology externs as part of the Ferkauf Older Adults Program.>>Female resident: What do you do in therapy?
I don’t know.>>Steven Hahn: In the med psych clinic, we
have patients who are referred from our own adult medical primary care practice and adult
medical specialty practices. So those are the patients that we see in this clinic>>Richard Zweig: Students who train here in
primary care train and deliver services to older adults as part of an integrated team.
That integrated team typically includes at the least medical residents and the psychology
trainee. They are literally at times in the same room together with patients learning
from each other as well as delivering integrated services to a patient. They are supervised
jointly in real time by both a psychology professional as well as a medical professional.>>Aliza Romirowsky: We are happy to figure
out with you what’s going on.>>Aliza Romirowsky: It’s been really great
to be in this kind of multidisciplinary environment. We’re able to be very independent when we’re
in training. And then we present each case to our supervisors. It’s usually a team.
There will be some residents there, both supervisors present, so we really get all the input when
we’re doing the supervision. Then we come back to the patient and finish up the session.
And then afterward we’ll kind of connect with social work or whoever we need for resources.>>Steven Hahn: The other thing that I think
is worthy of a little bit more exploration…>>Steven Hahn: The psychologists bring that
depth of understanding and that sophistication and the nuances of assessing cognitive functioning,
both instrumental functioning and other functioning in the lives of our patients.>>Richard Zweig: The modal patient that we
see is a patient who has not been seen in the mental health services before. Not had
any type of professional consultation before and may not even think of their problem as
a behavioral problem. And so we train our medical residents and doctoral trainees to
understand how to begin the conversation with such a patient.>>Tan Nguyen: Before my time in the Medicine/Psych
Clinic, I was personally very afraid of patients who had psychiatric conditions. I did not
know how to approach them in a manner that was meaningful both for the patients and for
my time with the patient.>>Tan Nguyen: What questions and concerns
do you have?>>Tan Nguyen: Most definitely I am more sensitive
to a patient’s psycho-social world, what’s going on in their homes, for example. What’s
going on in their workplace, for example.>>Aliza Romirowsky: One of the benefits of
us being an integrated care site is that at least coming to the clinic, a little bit of
the stigma is lowered because they’re going to the same place they used to go to, just
for their regular doctor. And so when they come in the patient may not themselves know
exactly why they were referred. They’ll often say, “My doctor just told me to come.”
And so when we get a full sense of what’s going on, then we can kind of validate all
the reasons that they think they’re here for and also all the reasons that we see might
also be warranting attention. And so it’s kind of a perfect combination that they get
to come somewhere familiar but also address new problems>>Richard Zweig: Think about the fact that
the first several sessions of psychotherapy may be like that.>>Richard Zweig: We know from research that
caregivers experience significant burden in caring for an older person with cognitive
impairment. We know that they are most concerned not about the memory problems but about the
behavioral symptoms that go along with the memory problems- something that psychologists
are uniquely equipped to address.>>Tan Nguyen: Effective care in today’s
world is about teams of people delivering coordinated care and that we all understand
what everyone is doing and Medicine/Psychology Clinic is a perfect example of how a successful
coordinated care system might be.

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