Luigi Solano, a professor at the University La Sapienza University in Rome for ten years putting into practice the trial. By breaking down the costs of pharmaceutical expenditure by 20%. But his research does not find funds to move forward
How many times your doctor has treated you as a "sick imagination"? How many times, coming out of quell'ambulatorio, however, you had to deal with anxieties, doubts and fears? The psychosomatic contemporary branch of study in between psychology and medicine, takes care of this, producing a wide range of research and experimentation. "Humanize" the practice of medicine, can also mean physically put in the same room physicians and psychologists. That 's what he is doing for 10 years, Professor Luigi Solano, Professor of Psychosomatic Medicine of the Faculty of Psychology at the University La Sapienza of Rome, which says: "Our experience has helped many people discover that the disease is often closely related to the particular situation you are experiencing. And this can have a much more powerful than any drug. "
What prompted you to take this experience of "co-presence" of a doctor and psychologist nell'ambulatorio base?
need from two considerations. On the one hand, doctors are increasingly difficult to deal with the patient as a person, and then to welcome all that share of discomfort (which is now estimated at least 50%) while presenting as somatic, hides in reality quite different origins, which are of a psychosocial nature. On the other you have to deal with the prejudices that still weigh on strong clinical psychology. To the doctor we're used to all be there. We've since birth, and it is given free of charge. With the idea that we are also obliged to go when we are wrong. Psychologist, however, is the idea that there are some people just a little 'details. The result is that, to paraphrase Woody Allen's famous quip: "You go to a psychologist only after they have been to Lourdes."
The doctor then it seemed the place of choice to enter the figure of the psychologist, whose task is to assist the doctor and take up the question of all those who apply. This enables us to intervene early in the discomfort.
you describe the actual research?
Our experience has been conducted within the School of Specialization in Health Psychology, University "La Sapienza" of Rome, which depends on the Department of Dynamic and Clinical Psychology, and was carried out as a form of training for postgraduate . These psychologists and enabled me to oversee a regular basis, discussing all the cases.
Our experience goes on for ten years now. Involving 11 psychologists, eight doctors were involved, each for a term of 3 years.
The psychologist is present once a week at the doctor's office and sees all patients, except those who specifically ask to be visited only by a doctor (this event occurred only four times). This approach has already proved sufficient to produce the results and effects.
The psychologist listens to what the person says and acts in the context of the visit. In some cases, not often, except proposed meetings (maximum ten) during which the problem develops with the person. In an even more limited number of cases you get to make a submission as possible to proper mental health specialists.
The problems are therefore already "Solved" in the outpatient setting?
Our aim is not primarily to treat people, but to give meaning to the symptom that is taken, especially if it is somatic in nature, within the context of a person's life. This is in most cases sufficient to shut down a medical path that leads to unnecessary costs, to label the patient, or even - if the person is not listening - to an escalation of more serious disorders. The primary sense of our work is to ensure that the person does not leave the doctor's office thinking of having a disease but thinking about having a problem.
We have often heard a patient say: "For a month I have vertigo, I would do a CAT scan." If this problem does not hear properly, your doctor will prescribe the Tac. If unfortunately this finding were to find some random, you risk getting to undergo further, more invasive tests triggered a perverse circuit that can also prove dangerous to the patient.
How did the doctors in the presence of the psychologist in their "sanctuary"?
Meanwhile, in the case of people who have agreed to join the experience, we can not consider them a representative sample of the class ... We had avoided medical specializations in psychology. The problem frequently has been the tendency of the physician to identify cases "as a psychologist." But our task is to identify the discomfort that is not seen.
And the patients?
A recent survey of the Order of Psychologists of Lazio showed that only 5% of people never came into contact with a psychologist over the lifecycle, including all training opportunities, company selection, and so on. This is a very low altitude. In such a difficult situation, when the psychologist is there for everyone, and no one runs the risk of being labeled, everything changes. People feel entitled to suddenly talk about things other than the somatic distress and symptoms.
many patients participating in the experiment?
In three years each psychologist has the encounter with about 700 people in 1500. Among these were found to psychosocial distress and sometimes quite serious in 40-60% of cases. This corresponds to estimates of the proportion of non-organic origin discomfort that comes to the physician who have always been done, starting with Balint 50s. The unease relates mainly marital problems, family members, including parents and children, the dynamics with the family of origin or the issues related to the phases of the cycle of life: school, work and retirement. In short, all the crucial stages of life.
Each psychologist has managed to do a hundred jobs with quite satisfactory results. These are numbers that have nothing to do with the use of psychology that is commonly done, ending almost exclusively to deal with cases that require a very thorough job. In our experiment, however, can be just a very limited intervention to change the course of events.
We are in the field of prevention.
Yes We certainly more in prevention than in the treatment of the disease.
There are similar experiences in other countries? We
experience of joint talks with the psychologist, also in terms of academic education, but always in selected cases. When the physician believes that this case is that for the psychologist. This leaves out a whole tranche of people who might need it, such as young people with serious organic diseases. We model we refer to "biopsychosocial" and we think that any kind of disease, even the really organic, is related to life situation.
You have found variations in the amount of medication prescribed by a doctor?
We had difficulty in obtaining data on health spending of the doctors who participated in the initiative. In a case that I am pleased to mention - Dr. Cappelloni of Rieti - we were able to analyze health expenditures in 2007, when the psychologist was not there, and comparing it with that of 2009, after two years of "co-presence." We found a decrease in pharmaceutical costs alone (ie excluding the costs for laboratory tests), the total number of clients, of € 75,000 a year, compared to a total expenditure of € 400 thousand.
A cost reduction of almost 20%. What does that mean?
Meanwhile, a large amount of damage to the pharmaceutical companies. I do not dwell on this fact and the negative consequences that could have for our project. It seems to me however important to note that these savings can be paid the salary of two psychologists, each of which could cover two surgeries. Imagining the presence of a couple of rounds at each doctor's office, you can cover a large number of patients.
At the end of three years, as the patients responded to the "disappearance" of the psychologist?
This was a big problem. The patients but also physicians, are always very sorry. On the other hand, the attempts so far to find a form of pay that would allow us to extend the stay of psychologists have not gone through.
What needs to happen for this experiment can be transformed into reality?
First you should make an official trial, agreed with the local health authorities, with those already formed, at least 4-6 surgeries, in order to verify more precisely the benefits to patients and physicians, and the effects on health spending.
Source: http://www.ilfattoquotidiano.it/2010/10/06/medico-e-psicologo-nello-stesso-ambulatorio-la-prevenzione-che-nessuno-vuole-finanziare/68497/
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