Providence Portland: Advanced Focus in Behavioral Medicine

Responsible Faculty:  William Merkel, Ph.D.; Richard Cohen, M.D.

Behavioral medicine is an interdisciplinary field that seeks to merge an understanding of biological and psychosocial perspectives with human health and well being.  This includes everything from improving interviewing skills to optimizing the doctor-patient relationship, understanding the interplay between emotions and health, diagnosing common office psychosocial/psychiatric problems, learning a range of psychosocial and pharmacologic interventions, and increasing self-awareness.

The Advanced Focus in Behavioral Medicine is concentrated in four broad areas:

1. Increase skill in the medical interview – This includes understanding both the impact of patient beliefs and expectations on clinical presentation and understanding the influence of one’s own values and beliefs on the medical interview.  Skills include negotiating diagnoses and treatment plans in patients with significant psychopathology and supervising younger residents to help improve their interview skills.
2. Increase resident self-awareness – After completing the Advanced Focus, the resident will be able to recognize and label specific reactions to specific patients and situations, be able to identify various aspects of one’s own interpersonal style, set limits congruent with personal belief systems and health system stewardship, and help teach other residents to tolerate uncertainty and ambiguity.
3. Adopt biopsychosocial model – This includes developing a working understanding of systems theory, learning to appreciate the psychosocial aspects of virtually any illness and understanding the interplay between illness and the family.
4. Increase ability to recognize and treat common psychosocial/psychiatric problems in primary care – After completing the Advanced Focus, the resident will be able to identify the most common Axis I psychiatric problems, have an increasingly sophisticated understanding of psychotropic drug choices and use, know some cognitive behavioral and office counseling techniques, and begin to learn how to teach basic psychosocial diagnosis and treatment to less-experienced residents.

There are several venues for the Advanced Focus in Behavioral Medicine, including the PACE Clinic and the Complicated Illness Clinic.  Opportunities are available for both direct “live” supervision as well as videotape review.  The Advanced Focus resident will also be involved in supervised teaching of less-experienced residents about psychosocial aspects of care and will be asked to present one Behavior Medicine noon conference.

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