Body, mind & spirit: Integrating primary and behavioral care


When you go to the doctor complaining of stomach pain, you probably don’t expect your problem to be depression. But it just may be. When you complain of headache, clumsiness, dizziness, shakiness, blurred vision, tingling around the mouth and seizures, you might expect an anxiety or bipolar (manic-depressive) disorder. You may be surprised if the problem is hypoglycemia, a low blood sugar disorder treatable by diet and exercise.

Diseases can mimic each other, making them harder to diagnose in a typical 10-15 minute appointment. Doctors may not have the patient’s full medical record or lack specialized training. Problems can be compounded when patients don’t believe their condition is behavior related.

Depression can sometimes show its initial symptoms by severe abdominal pain, explains Dr. Dean Shull, president of the Polk County Medical Association. “Many don’t feel depressed.” When patients get a surprising diagnosis, Dr. Shull finds getting a second opinion from a qualified provider helps convince the patient to pursue treatment. “The respectful approach is to allow them two doctors,” says Dr. Shull, a semi-retired psychiatrist from Winter Haven.

Yet shortages of medical providers, U.S. economic woes, and high health care costs are making it important to get quick help. As a result, Polk County health care providers are looking more strongly at treating the whole person – otherwise known as holistic or integrated medicine.

“The lack of coordinated care between a psychiatrist and a primary care doctor can produce a very high cost of health care,” says J. Gilbert Sierra,chief executive officerof the Bartow-based Peace River Center, a private not-for-profit community mental health organization. “They are treating the symptoms and sometimes not looking at the person as a whole.”

Integrating health care treatment is a “priority solution,” says Sierra, who also co-chairs the Exploration and Development Committee of the Polk County Health Care Alliance, a group of health care providers working to improve heath care access. “The ideal setting is to have centers that are fully integrated — primary care, behavioral care, and dental all in one building.”

While there are shortages of doctors in other areas, in Polk County the situation is more acute, says Scott Ponaman, of Ponaman Healthcare Consulting in Scottsdale, Arizona. The whole county is recognized as an area underserved by primary care, psychiatric and dental providers. On average there is one medical provider per 3,000 residents, he explains. By comparison, a doctor handling insured patients might typically have 800 to 1200 patients. “Right now the county has over 100,000 uninsured,” Ponaman says.

Ponaman was hired as a consultant to conduct a health needs assessment for the county’s Citizens Healthcare Oversight Committee. The assessment financed by the Washington D.C.-based Heinz Foundation shows there are current and projected shortages of health care providers, especially those accepting new patients and lower Medicaid reimbursement rates. The hope is that federal dollars can help lessen the county’s load.

Among changes proposed are 1) sharing electronic medical records and 2) raising awareness about how mental illness and other diseases can overlap. Peace River Center is raising awareness through a junior advisory board they have trained as speakers for the schools.





Accessibility Toolbar