Technician, friend, detective, and healer: Family physicians' responses to emotional distress

OBJECTIVE: We developed a typology of physicians' responses to patients' expressed mental health needs to better understand the gap between idealized practice and actual care for emotional distress and mental health problems. STUDY DESIGN: We used a multimethod comparative case study design of 18 family practices that included detailed descriptive field notes from direct observation of 1637 outpatient visits. An immersion/crystallization approach was used to explore physicians' responses to emotional distress and apparent mental health issues. POPULATION: A total of 379 outpatient encounters were reviewed from a purposeful sample of 13 family physicians from the 57 clinicians observed. OUTCOMES MEASURED: Descriptive field notes of outpatient visits were examined for emotional content and physicians' responses to emotional distress. RESULTS: Analyses revealed a 3-phase process by which physicians responded to emotional distress: recognition, triage, and management. The analyses also uncovered a 4-quadrant typology of management based on the physician's philosophy (biomedical vs holistic) and skill level (basic vs more advanced). CONCLUSIONS Physicians appear to manage mental health issues by using 1 of 4 approaches based on their philosophy and core set of skills. Physician education and practice improvement should be tailored to build on physicians' natural philosophical proclivity and psychosocial skills.