Lecture 6 – Working with Medical Providers
Talking to Your Client
S Assess beliefs, fears and worries about medications.
S Assess side effects duration, intensity and frequency.
Look up side effects, consult with a provider and develop plan to
minimize their impact.
S Address Concerns:
S Normalize and use as opportunity to develop increased self
S Support client to discuss concerns with clinician. (Clinical goal:
Healthy boundaries and assertiveness).
S Support cleint to research normal and high risk side effects and
empower them to understand their treatment.
S Develop Interventions to Minimize Impacts of Side Effects
S Collaborative Care is a diverse set of healthcare
protocols that incorporate health, behavioral health and
substance abuse services into primary care treatment.
S Three Models:
S The shifted outpatient clinic,
S The consultation liaison model, and
S The attached-mental health professional model.
S The Attached mental health model: Behavioral Health
professionals are attached to a primary care practice and
are a part of extended care services.
Activation of CRF1
which can be
blocked by CRF1
Psychological Impacts of
Core beliefes about medical
Change in cognitions: Self, world,
Adjustment to the medical
Chronic psychological strain.
Adjustment to Medical
S Grief Stages: 1. Deniel and Isolation, 2. Anger, 3. Bargining, 4.
Depression and 5. Acceptance.
S Developing Adaptations: Living with a chronic illness or dissability
requires adapting life and building tools to make our life a good life
S Understanding diagnosis and how to work with it: Often medical
information is confusing and overwhelming. Psychologists can be
invaluable to catch missunderstandings and develop realistic
apprasials of current abilities.
S Dealing with Ablism: Bigotry is real. It impacts how safe we feel
with each other. However developing a positive identity can
support the transformation of an impediment to a stregnth.
Physiological Impacts of
S Impacts of diagnosis on stress response: Asthma, COPD,
Diabetes, and chronic pain.
S Impacts of diagnosis on mood: Lack of exercise, impacts
concentration, impacts cognitive functioning.
S Impacts of diagnosis on sleep, eating, breathing, self-care
and other basic functions. (Aleostatic load)
S Impacts of diagnosis on ability to do things one enjoys and
have ease daily living.
S Impacts of diagnosis on cognitive functions (Thoughts,
cognitions, awareness, delirium or dementia).
Social Impacts of Disease
S Change in ability to socialize through reduced energy,
focus, stamina and ability.
S Poor understanding of disease by friends and family (get
over it, or poor them).
S Change in physical appearience.
S Change in role in family system.
S Change in ability to engage sexually or romatically.
a disabled Iraq War
veteran who was
elected to represent
district of Illinois in
the U.S. House of
Medication of the
S Describe a medication briefly,
S Describe what it is used to treat
S Describe its side effects
S Describe other relivent information.
S Identify clinical cases for case consult at end of training
that have a pharmachologcial and a health component of
S We will have 30 min for case consultation starting at 3:30.
a Dissorder Based Approach
S Detailed and clear diagnosis as route to best possible
treatment (Differential diagnosis and co-morbidity).
S Symptoms cluster to dissorder if you treat the main
causes you treat the dissorder.
S Dissorder Based treatment matches the diagnosis with
proper treatment protocol.
S Depression – CBT, SSRI.
S Seizure dissorder – Neurontin (or other anticonvulsent),
identifing prodromals, safety planning, increased self-care
and stress reduction.
a Symptom Based Approach
S Identify core symptoms effecting paitient (e.g. sleep, lack of
hunger, lethargy, social anxiety, impulsivity, irritability,
S Consider bodily system driving the symptom and its context
to assess ways to possibly address symptom (e.g. chronic
pain leading to nocturnal rousals - long acting pain
medication at night combined with tricyclic).
S Consider psychopharacological intervention to reduce
symptoms impact on quality of life.
S Psychologists have begun to realize just how valuable
psychopharmacological training can be.
S Psychopharmacological training for psychologists is the new face of
S It can prepare the psychologist to
S (a) Collaborate with physicians in order to craft the right
psychopharmacological regimen for their mutual patients.
S (b) Recognize which symptoms are likely to benefit from the use of
S (c) Examine possible drug–drug interactions.
S (d) Make sure that the prescription decisions being made are actually in
the best interest of the patient.
S Prescribing (Louisianna, New Mexico, Navey)
Significant post graduate training.
S Colaborating – Actively engage with support
and dialog about paitient care and medication
S Providing Information – Discuss medication
information, identify client concers, support
adherence, identify side effects and
communicate concerns with providers.
Working with Medical
S People become doctors to help. Medical providers want
their patients to do well.
S Basic Prinicipals of Clinical Consult with Medical
S Listen to the consulting question.
S Be cofortalble with the limits of your knowledge but speak
the providers language.
S They are the provider you “make a recommendation for a
S Be focused and direct. Say concerns in 3 sentenses or less.
S Give suggestions through questions.
Psychologist Role in Medical
S Psychologist Role in Medical Collaboration:
S Develop clinical team and facilitate communication.
S Support secure attachment between client and health provider.
S Support client to be assertive with questions and needs.
S Provide direct understanding of impact of medical intervention on
client (side effects, medication complience and changes in
S Provide neuanced understanding of psychological conditions for
S Support treatment adherence and know when treatment is not
working and urge team to change treatment.
Working with Psychiatrists
S Psychologists see their cleints more often then psychiatrists and our
input can be vital.
S Many issues require a tag team approach working from both angles
(e.g. medication adherence, moving from pre-contemplative to
S Keep medical explinations on the radar.
S Important: Building clinical relationship, recognizing and accepting
higherarchy, one down position, effective questions and listen well.
S Good statement: “I have been noticing ___ have you noticed it?” and
follow, “what do you think about it?”
S Good questions:
S What would help your work?
S What would you like the client to know about their medcations?
Primary Care Physiscians
S Psychologists see paitients more often
S Psychologists can communicate
about psychological symptoms and
support neuanced decisions about
S Develop the collaboration with
S Build care team. Identify the appropraite
range of services. Keep members informed. Address concerns.
Be willing to call for team meetings.
S Support attachment between medical provider and their patients.
S Nursing staff are the backbone of the organization. They make
everything happen. Many medical errors are caught by nurses.
S Nurses in some areas prescribe with a physician supervisor.
S Nursing as a culture tends to be practical, direct and results focused.
S Nurses provide a large amount of direct information and are integral
to patient care.
S Defference to their knowledge and expertise as well and seeking
their input can increase you knowledge and efficacy as well as your
direct impact on patients.
Types of Nurses and
S CNA Certified Nursing Assistant - The education and experience for a CNA is limited,
therefore so are the job responsibilities (not considered a nurse).
S A Licensed Practical Nurse (LPN) or Licensed Vocational Nurse (LVN): Perform all
job duties of a CNA, plus more in-depth care, such as administering medications,
injections, starting Ivs, develop patient care plans. LPNs/LVNs cannot fill doctor's
orders directly, they must take their orders from higher level nurses.
S A Registered Nurse (RN) can perform all tasks of CNAs, LPNs, and LVNs and can
take orders directly from doctors. They also operate medical equipment, administer
IVs, give medications and injections, assist in surgery, administer care plans and sign
off another nurse's work.
S Master of Science in Nursing (MSN) programs, RN to MSN programs, and graduate
specialty diploma programs are available, as well as PhD doctorates for students
who wish to pursue advanced nursing work and/or research.
S Advanced Practical Registered Nurse (APRN) specializes in certain types of complex