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

OBJECTIVE We developed a typology of physicians' responses to patients' exp ressed mental health needs to better understand the gap between idealized p ractice and actual care for emotional distress and mental health problems. STUDY DESIGN We used a multimethod comparative case study design of 18 fami ly practices that included detailed descriptive field notes from direct obs ervation of 1637 outpatient visits. An immersion/crystallization approach w as used to explore physicians' responses to emotional distress and apparent mental health issues. POPULATION A total of 379 outpatient encounters were reviewed from a purpos eful sample of 13 family physicians from the 57 clinicians observed. OUTCOMES MEASURED Descriptive field notes of outpatient visits were examine d for emotional content and physicians' responses to emotional distress. RESULTS Analyses revealed a 3-phase process by which physicians responded t o emotional distress: recognition, triage, and management. The analyses als o uncovered a 4-quadrant typology of management based on the physician's ph ilosophy (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 ed ucation and practice improvement should be tailored to build on physicians' natural philosophical proclivity and psychosocial skills.