Conclusion

To practice in a way that sensitively integrates psychosocial concerns, a physician needs to have a solid knowledge base in the social and behavioral sciences (Cuff and Vanselow, 2004). This general knowledge base complements specific knowledge of self, patients, practice, and community. Self-knowledge entails an honest assessment of the physician's knowledge base, skills, and attitudes relevant to comprehensive care. Acknowledging limitations in dealing with psychosocial issues in primary care is vital and can serve as an impetus to pursue further training and to develop appropriate collaborative relationships with other professionals. The responsible physician feigns neither knowledge nor empathy, but relies on an interdisciplinary network of professional and community resources to complement personal limitations.

Knowledge of each patient is also requisite to the provision of sensitive psychosocial care, with attention to life stresses, coping, personality, and social resources. As Osler (1904) emphasized, knowing what kind of person has a disease is as important as knowing the disease. Also, the physician needs to know the population, including demographic, socioeconomic, cultural, and epidemiologic dimensions. Addressing psychosocial issues in a practice that serves an ethnically diverse, indigent population presents different challenges than addressing the needs of an affluent population from a familiar ethnic and cultural background. Understanding the practice also entails knowing the health care economics and current systems of care, which inevitably introduce challenges to comprehensive care.

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