|
Psychologist,
physicians collaborate on
patient care
(May
2005 Issue)
As the fields of medicine and psychology continue to overlap, positions
like the one created by and for Ellen Dornelas, Ph.D., at Hartford
Hospital may become much more common. For now, her role as director
of behavioral health programs for the hospital's Preventive Cardiology
department is somewhat unique.
Dornelas, who works full time at the hospital and also has a faculty
appointment at the University of Connecticut, spoke with New
England Psychologist's Catherine Robertson-Souter about her
job and the ways in which psychology can work together with and
enhance the efficacy of cardiology and medicine in general.
Q: You work in a hospital setting with cardiology patients.
Tell us about the set up there. A: Well, in Preventive Cardiology
we offer behavioral health programs like smoking cessation and stress
management counseling and also individual psychotherapy. In the
same suite, also under the preventive cardiology umbrella, there
is cholesterol management, cardiac rehabilitation and an athlete's
heart program for elite athletes who have heart problems.
In my area, I have a full-time licensed counselor, a part-time
research psychologist, a full-time post-doctoral fellow, a full-time
research associate and various trainees who come through along with
administrative support.
In a 40-hour work week, I see about 10 clinical patients and I
do about 20 hours of research time and another 10 of administrative
functions - doing a lot of the training. I usually teach the stress
management and smoking cessation classes.
Q: There are not many positions like yours in hospitals.
A: I am not aware of any other hospital. Generally, hospitals
will have somebody come in to teach a stress management course or
they will refer out to a private practice.
I think the difference is that, because we work side by side, there
is a lot more day-to-day interaction on clinical issues and there
is a much richer sense of how to help a patient. For example, say
there is a compliance issue - a patient not following through on
something the provider wants. In a traditional setting, the provider
might get a psychologist involved by giving the patient a referral
but because it's a compliance issue, the patient won't make the
appointment. With our set-up the provider will call me up, strategize
a bit and I walk down and meet the patient, which increases the
likelihood that the patient will come to the appointment. Mental
health is unfamiliar for many medical patients and it's stigmatizing,
so putting a face with the therapist's name helps to warm them to
the referral.
Q: How did you get to this position?
A: I actually created this program from the ground up.
I worked at other hospitals; doing outcomes research with psych
patients, in a large women's health ambulatory service there, doing
administrative work during college for a cardiologist, etc. I always
thought there was a way to bring together psychology with the different
kinds of stressors patients seem to face after a big event.
There was an accreditation requirement on the hospital side that
cardiac patients get smoking cessation before they left the hospital
but there was no systemic way to ensure that happened. I started
with the smoking cessation program and that broadened over time
to include the other programs as well. Smokers would come in and
we would find that it was often not just smoking. There was smoking
plus depression or marital issues or an adjustment to a big heart
attack. Developing the psychotherapy program was a natural fit.
I have worked hard at my hospital to help expand the role of psychology.
We now have a psychologist in our women's health department. It
was hard work to establish that position but it's an exciting change.
It would be great to have a psychologist in each of the hospital
divisions because it so enriches what you can offer to patients.
It only augments the work that other professions do. It doesn't
compete. It really only adds to it.
Q: You mentioned that you spend time each week on research projects.
What type of research do you do?
A: There are three areas: the first is a study about whether a variation
of the serotonin transport gene predicts depression in cardiac patients.
The implication is that if it is true you would respond differently
to SSRI-type drugs.
The second study tests a model called 'Treating Affect Phobia.'
It's a manual therapy and we are testing that to see if it would
be effective for ante-partum depression.
The third part is smoking cessation research. We have a $1.6 million
National Institutes of Health funded study that we do in collaboration
with the University of Connecticut Health Center. We are looking
at the safety and efficacy of using nicotine gum during pregnancy.
The dosage of nicotine that is delivered in the gum is so much lower
than with smoking and you get only the nicotine as opposed to all
the harmful things like carbon monoxide delivered to the fetus.
Q: Smoking cessation is a big part of what you do. Can psychology
hope to make a difference with getting people to stop?
A: I would love to someday be out of business with the smoking cessation
program but it doesn't look like that will ever happen. There is
so much that psychology can do with smoking cessation. Many people
smoke because they feel anxious or depressed. It makes it very difficult
to quit. People who stop smoking anecdotally tend to be in a good
place in their lives. They say, 'This is last thing. I've always
wanted to quit smoking and now I can do it.'
Q: What will the future hold for psychology and traditional
medicine?
A: I think in the future we will see more of an integration
of mental health into the delivery of routine health care. It's
better health care. It's more cost effective. Patients ask for it.
Many patients use their primary care physicians as counselors. They
go when they are feeling down and depressed. They don't use the
mental health care system.
I think a lot of how psychology gets integrated depends on the
willingness of our profession to embrace changes and get out of
some of the models that we've been trained in or to be flexible
enough to try different models. It can be hard for psychologists
to change to a different treatment format, to work in a 20-minute
block rather than to work for an hour or to see someone on the inpatient
side rather than only in an outpatient setting. Physicians don't
want long reports from a psychologist, they want just a concise
one- to two-page note - and that can be hard for psychologists.
Q: How would you recommend a psychologist learn more?
A: There are a number of different areas that train in health
psychology - but getting clinical experience is harder. Look on
the APA's Divison 38: Health Psychology Web site or the Society
of Behavioral Medicine Web site. They offer all kinds of training
opportunities.
Rehab hospitals usually offer health psych but getting right into
medicine can be somewhat of a challenge. So, seeking out any experience
where you get exposure to medical patients is wonderful. Because
there are a limited number of psychologists who are physically located
in hospitals and do clinical work with medical patients in that
setting, it becomes hard to get training experience. The hardest
part is getting a foot in the door and finding someone to supervise
you. You need to be willing to carve out a new path rather than
to follow someone else's footsteps. It takes that spirit to be willing
to not completely know what you are doing.
|
