Sara Guevara, MD
Montefiore Medical Center, Bronx NY
Understanding the importance of the mind and body connection was one of the most important goals early in my medical career. My interest in becoming a primary care provider was initiated by witnessing the necessity of practicing medicine within a biopsychosocial model of medicine to provide optimal health care and help address health disparities. During my family medicine residency, I had the amazing opportunity to co-train with clinical health psychology fellows training in a primary-care psychology program within a collaborative care model. My experience working alongside clinical health psychologists has allowed me to provide more advanced primary care with integrated behavioral health, and it has also enriched my training experience by allowing me to learn additional skills to incorporate into my patient encounters.
One of the most memorable experiences during residency took place while working alongside a clinical health psychology fellow, Dr. Wendy Alfaro, in clinic. I was preparing to have a serious illness conversation and offer support and resources for my patient who was suddenly diagnosed with pancreatic cancer, while also recovering from Whipple surgery, and was soon to initiate chemotherapy. I had seen my patient for a year prior and understood how important her role as a caregiver was for her wellness and sense of purpose. The sudden diagnosis and major surgery would now transform her role to receiving care. The clinical health psychology fellow and I met prior to the patient’s appointment to discuss our objectives and how to organize our conversation as a team. During the visit, I learned more about the patient’s understanding of her prognosis and how she felt her experience was impacting her physical and mental health. Dr. Alfaro interviewed her as well and together we mapped a genogram to identify the patient’s support network. After the visit, Dr. Alfaro and I had the opportunity to reflect about our encounter and identified important themes which I could use in the future to tailor patient care in a more holistic way. We also learned more about ways to facilitate and strengthen the patient’s already existing support network. We later presented the lessons learned from our different perspectives and shared our observations with other providers during our monthly psychosocial seminar.
The importance of interdisciplinary care is highlighted daily in my practice of the biopsychosocial model of medicine. My colleagues and I are able to identify the root cause of the recurrent hospital admissions or challenges for medical adherence, and often we discover that the patient has been struggling with underlying mental health conditions or other potential barriers we can address as an interdisciplinary team. For example, the transition to care, a new diagnosis, change in prognosis, smoking cessation, or other behavioral changes are often addressed in teams alongside health psychologists. Patients visiting our federally-qualified health center for primary care often face other barriers to accessing care and having clinical psychologists on site has greatly increased access to mental health resources. With the integrated care model, we can have a greater impact in addressing the social determinants of health.
There are innumerable benefits of co-training psychology fellows and primary care residents in a collaborative care model, including access to a network of behavioral health faculty and experienced health psychologists. I have had the unique and invaluable opportunity to develop my skills in providing trauma-informed care under the supervision of clinical psychologists which has taught me to incorporate patient centered care with a holistic approach that reflects the biopsychosocial model of medicine. Working alongside psychologists has also allowed me to better understand when to make appropriate referrals to mental health providers. I have had the opportunity to provide warm handoffs to clinical psychologists and expand the team’s support for each patient. It has been transformative to participate in interdisciplinary team meetings to discuss complex cases and co-develop treatment plans. My past experiences working with clinical psychologists have deeply impacted my practice of medicine and goals as a provider. In the future, wherever I am to practice medicine, it will be a requirement to have access to an interdisciplinary team, alongside health psychologists, in order to provide optimal health care.