Storylines of family medicine VI: ways of being-in the office with patients.

Storylines of Family Medicine is a 12-part series of thematically linked mini-essays with accompanying illustrations that explore the many dimensions of family medicine, as interpreted by individual family physicians and medical educators in the USA and elsewhere around the world. In 'VI: ways of being-in the office with patients', authors address the following themes: 'Patient-centred care-cultivating deep listening skills', 'Doctor as witness', 'Words matter', 'Understanding others-metaphor and its use in medicine', 'Communicating with patients-making good use of time', 'The patient-centred medical home-aspirations for the future', 'Routine, ceremony or drama?' and 'The life course'. May readers better appreciate the nuances of patient care through these essays.

Optimal training in communication model (OPTiCOM): A programmatic roadmap.

OBJECTIVES: Teaching primary care residents patient communication skills is essential, complex, and impeded by barriers. We find no models guiding faculty how to train residents in the workplace that integrate necessary system components, the science of physician-patient communication training and competency-based medical education. The aim of this project is to create such a model. METHODS: We created OPTiCOM using four steps: (1) communication educator interviews, analysis and theme development; (2) initial model construction; (3) model refinement using expert feedback; (4) structured literature review to validate, refine and finalize the model. RESULTS: Our model contains ten interdependent building blocks organized into four developmental tiers. The Foundational value tier has one building block Naming relationship as a core value. The Expertize and resources tier includes four building blocks addressing: Curricular expertize, Curricular content, Leadership, and Time. The four building blocks in the Application and development tier are Observation form, Faculty development, Technology, and Formative assessment. The Language and culture tier identifies the final building block, Culture promoting continuous improvement in teaching communication. CONCLUSIONS: OPTiCOM organizes ten interdependent systems building blocks to maximize and sustain resident learning of communication skills. Practice Implications Residency faculty can use OPTiCOM for self-assessment, program creation and revision.

"Imagine a clinical world without family systems thinking": Response.

Replies to comments made by B. J. Jacobs (see record 2018-27937-015) on the authors' original editorial (see record 2017-56601-001). While Fogarty and Mauksch agree with Dr. Jacobs that reviving the Doherty and Baird Levels of family involvement would be helpful, as would training clinicians to engage family members as partners in care, Fogarty and Mauksch want to reemphasize that helping trainees recognize systemic thinking and learn systemic problem solving is a necessary precursor to any form of family focused action. Clinicians should pursue shared decision-making partnerships with patients and their family members. (PsycINFO Database Record

"Imagine a clinical world without family systems thinking."

Collaborative family health care acknowledges the importance of family and social context to yield a comprehensive understanding of health. In this editorial, we return to the concept of family systems thinking. (PsycINFO Database Record

Collaborative family health care, civil rights, and social determinants of health.

Social and economic disadvantage and civil rights infringement, worsens overall health (Adler, Glymour, & Fielding, 2016; McGowan, Lee, Meneses, Perkins, & Youdelman, 2016; Teitelbaum, 2005). While addressing these challenges is not new, there is reason to believe that the administration of Donald Trump and a republican majority in congress will exacerbate these challenges and their effects. How can collaborative family health care (CFHC) practitioners and our field help? The editors pondered this question and also asked a selection of leaders in the field. The editors will first share their ideas about the potential of CFHC to make a difference in daily interactions with patients. Next, they will identify key areas of risk and vulnerability. Finally, using the contributions of respected colleagues, they will propose a partial agenda for CFHC clinicians and the field. (PsycINFO Database Record

Our continuing exploration of medically unexplained symptoms.

In this issue, the reader will find three articles examining different but converging perspectives on medically unexplained symptoms (MUS). In the first article, Gates, Petterson, Wingrove, Miller, and Klink (2016) examined 110,000 office visits to primary care providers between 2002 and 2010. In the second article, Clarke (2016), an internist and gastroenterologist, presents a model for diagnosing and treating MUS. The person most referenced in the first two articles and author of the landmark study-Kroenke (2016) writes the third article, an invited commentary. Kroenke eloquently reviews the major issues confronting health care clinicians dealing with MUS. We hope that readers of the three articles on MUS in this issue will reflect on their own practice, share these articles and their impressions with colleagues, and consider ways to improve the service and consultation designs in their practice settings. Those who teach behavioral health clinicians and physicians will surely be reinforced or reinvigorated to focus on ways to help patients and colleagues. (PsycINFO Database Record

Families, Systems, & Health: The past and present help determine the Journal's future.

This editorial introduces the current special issue of Families, Systems, & Health. This special issue on "Integrated Care Strategies in the Real World," guest edited by Jennifer Funderburk and Jodi Polaha, will offer rigorous studies and provide practical recommendations for others to apply scholarly knowledge in real practices.

In search of a perennial philosophy for behavioral health integration in primary care.

The "perennial philosophy," a concept religious scholars have studied for centuries, represents a search for the values, themes, and constructs that transcend individual religions. Can we who develop and disseminate behavioral health integration in primary care step back from individual models to identify our perennial philosophy? If so, what are the components? What does the evidence tell us? What do we need to learn? Four case examples are presented which represent many patients seen by both of us-a family therapist and a family physician-over our combined 55 years of collaborative practice within integrated primary care settings. Can these patients be cared for in a primary care setting? Our experience provides a simple answer-yes. However, providing care for this range of patients requires variability in team configurations, frequency of visits, lengths of relationships, and interventional strategies. Is there a perennial philosophy of how to design and implement the integration of behavioral health in primary care? We think there should be. we highlight a recent publication from the Eugene S. Farley, Jr. Health Policy Center, entitled "Core Competencies For Behavioral Health Providers Working In Primary Care." The authors purposefully transcend models in delineating eight core competencies. Embedded within these competencies are common or perennial factors. These factors may guide our field going forward, helping us avoid "religious" divisions, seek to understand diverse designs, and embrace integration of models to meet the needs of the populations and teams we serve. (PsycINFO Database Record

The Tri-Optic II: Embracing the family voice.

In June, 2015, for the issue marking the passing of Donald Bloch, the intellectual founder of the collaborative health care movement, we wrote an editorial called, "The Tri-Optic: Next step for Collaborative Family Healthcare" (Mauksch & Fogarty, 2015). Bloch had famously proposed the "dual optic": the partnership of Dr. Biomedicine and Dr. Psychosocial (Bloch, 1988). Our readers, including many Collaborative Family Healthcare Association (CFHA) members, understand the value of a family perspective and are grappling with the next steps to truly integrate family and systems thinking into all levels of health care. A current exploration about the last 10 years of articles published in the journal by Tai Mendenhall, a member or our editorial board (personal communication, 2015), has found that the most common topic of focus is family health and functioning in 28% of the articles. This focus was also evident to varying degrees in all the plenaries at the 2015 CFHA conference held in Portland, Oregon. we pose the following questions to the FSH readership and CFHA community: Where are we, individually and collectively, with our knowledge about families as resources in and influences on health care? How are we teaching our learners about family-oriented care? How do we integrate family thinking into our various models of care? How do models of behavioral health integration include the family context in patient care?

Empiric and creative: Are these opposed?

We feel proud that Families, Systems, and Health disseminates different ways of knowing, and different ways of influencing thought: empiric work such as research papers and conceptual papers in contrast to creative work such as personal narrative, poetry, and 55-word stories. In this issue, we feature an interview with Dr. Julie Phillips, a family physician, scholar, and poet, who has contributed both research papers and creative manuscripts to the medical literature. Our commitment to publishing creative writing is balanced by our longstanding pursuit of scientific knowledge, which also requires creative thinking. In this issue, three knowledgeable scholars and members of our discipline set forth a call for papers for a special issue. Jodi Polaha, Ph.D., Jennifer S. Funderburk, Ph.D., and Deborah Cohen, Ph.D. will be the guest editors of a future issue blending two goals. We want to help our readers learn how to study their innovations and describe their learning so others can benefit. This special issue of Families, Systems, and Health seeks contributions from authors willing to help others learn to generate generalizable learning. In the process of doing this, we hope they will share the results of their studies to improve, implement, and disseminate integrated health care. (PsycINFO Database Record

The tri-optic: Next step for Collaborative Family Health Care.

C. J. Peek, PhD, is a descriptive psychologist, someone trained to organize and define the implicit structure of a discipline. Dr. Peek applies his training to name and organize the content of Collaborative Family Health Care (CFHC) and to examine our next developmental steps. In Dr. Peek's article (see record 2015-25290-002), the reader will find a clear examination of the CFHC organizing principles, visionary components, 20 years of planning, CFHC core competencies, and outcomes. According to Seaburn (see record 2015-10057-002), the impetus for Peek's work comes with the passing last year of Donald A. Bloch, MD, the principle person who envisioned our discipline, founded our organization, and launched this journal.

Reflections.

Times that prompt reflection include anniversaries, deaths, and birthday celebrations. September 2014, Donald A. Bloch, MD died. He started this Journal (formerly Family Systems Medicine) and the Collaborative Family Health Care Association (formerly Coalition). Don's death occurred just one month before CFHA celebrated its 20th year. In this issue and our June issue, Families, Systems and Health devotes space for reflection. We begin with a remembrance of Don, written by his friend, mentee, and colleague, David Seaburn, PhD, LMFT. We also reflect on the 20th annual CFHA meeting, where we could see Don's vision at work in the plenaries. In our June issue we will publish a second article written by CJ Peek, PhD, about Don's vision of the field, the organization (CFHA), and this Journal. The article will ask readers to reflect.

"That's why they call it practice".

The authors discuss how, as their residency family medicine practices are transforming into Patient-Centered Medical Homes, they are witnessing shifting expectations for everyone: medical assistant, faculty and resident physician, licensed practical nurse, behavioral health clinician. At all levels of experience and expertise, they are called on to change. In the health care context, "practice" has multiple meanings. Practice, in the sense of "the clinical scope of work we do every day" corresponds to Merriam Webster's first definition of the word, "to be professionally engaged in" or "to do or perform often, customarily, or habitually." In this editorial, the authors call upon their colleagues to recognize the second definition of "practice" and build in opportunities to "train by repeated exercises" within day to day clinical activity. By this they mean, build in mechanisms to prompt reflection on your work, every day, seeking and incorporating feedback from others on your team. Effective primary care systems protect time for practice and learning. These organizations demonstrate "adaptive reserve," consisting of action and reflection cycles, facilitative leadership, a learning culture, the ability to improvise, and effective relationships and communication.

How do we know when to celebrate?

This editorial presents a brief historical overview of emerging knowledge since the 1970s that led to the birth of a new discipline, Family Practice (now Family Medicine). Family Medicine residencies were required to include training on mental health, family dynamics, communication skills, and other behavioral science topics. The next two decades witnessed an explosion of clinical research. High users of general medical services were found to have a two- to threefold higher prevalence of mental illness. These patients consumed disproportionate amounts of health care dollars, suggesting that cost containment may require mental health treatment. Over the last 30 years researchers have demonstrated that combining biomedical and psychosocial expertise in collaborative treatment models produces better outcomes for patients with mental illness, with physical illness, and for the majority who have a complicated mixture of biopsychosocial ailments. The advent of collaboration between disciplines and the integration of service designs is something to celebrate. In this issue of Families, Systems and Health, representatives of eight organizations, spanning behavioral health, nursing, medicine, and interdisciplinary practice, all endorse behavioral health integration in the health home. (PsycINFO Database Record (c) 2014 APA, all rights reserved).