Important Times for Psychosocial Interventions

Interventions that attend to psychosocial issues are especially important at specific times in the provision of family medical care. Natural transitions in the family life cycle, such as the birth of a child or the death of a spouse, call on the physician to provide empathic support, assess the patient's support system, normalize emotional reactions, and provide anticipatory guidance as patients confront changing family roles and functioning.

When adherence or lifestyle issues impinge on health, interventions that focus on biologic mechanisms alone are likely to be ineffective. The health effects of substance abuse, domestic violence, poverty, or inactivity are often best addressed through attention to social environment and psychological concerns.

A dramatic change in patient symptoms also indicates consideration of psychosocial factors. A psychosocial crisis can provoke an exacerbation of a chronic condition (e.g., rheumatoid arthritis), a new manifestation of illness (e.g., myocardial infarction), or emotional-psychiatric symptoms (e.g., anxiety, trouble sleeping) best treated through stress reduction and symptomatic care.

A significant medical diagnosis may precipitate emotional distress or psychosocial upheaval and requires physician attention to the context of the patient's life. Effective physician intervention may involve anticipating the nature of the potential family crisis, including family members in discussions with the patient, and addressing family needs for support. Timely provision of accurate information can enhance a patient's sense of control. Direct support by the physician during the initial adjustment phase can minimize more serious emotional disruption.

Patients living with chronic illness require sensitive psychosocial care. Managing a chronic health problem challenges a person's ability to adhere to a myriad of medical recommendations, making it more difficult to cope with other life stressors. Patients often deal with the predictable set of issues in highly idiosyncratic ways. Adequate attention to these issues can make medical management easier and more successful. These issues can often be effectively addressed within the physician-patient relationship and through judicious referral to support groups for chronically ill patients. Pollin (1995) identified eight emotionally charged issues that patients with chronic illnesses inevitably confront: control, self-image, dependency, stigma, abandonment, anger, isolation, and death. The professional stance useful in assisting the patient with each issue is important. In response to control issues, for example, professionals should help patients express their feelings of loss of control and to identify areas where they may feel powerless. Normalizing the patient's feelings and fears is the first step in helping address control issues. The goal of intervening in this issue is to reinforce the patient's confidence in being able to cope with the demands of the medical condition.

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