Sandy's post is the third
in a 5-part series on
One of the roles of leadership in a field is being comfortable speaking
on behalf of the field. To do that, it helps to have a clear summary
that is understandable to someone outside the field. One name for that
summary is an "elevator speech. It
is called that because it designates what a person could say to
another person while making conversation riding together a few floors in
I had an opportunity to try out my skills at the elevator
speech for integrated primary care not long ago on an airplane. I was
seated next to a gentleman for a couple of hours but we didn’t start to
speak until the last 10 minutes of the flight. He was
a guy who has to fly a fair amount because he has several small
businesses. The businesses were quite varied. He was clearly a self-made
guy who was doing OK but was not extremely successful, an entrepreneur
on a comparatively small scale. He knew about doing
everything his own way and he made his own decisions. It was not in an
elevator, but we were changing elevation and the length was only
slightly longer that a 15 floor ride in a high rise.
This is not verbatim, but close, and the last line is a quote.
The conversation went something like this:
Bob: So, do you come to San Diego on business or pleasure?
Sandy: Business, I’m here for a conference on integrating mental health into primary care.
Bob: What’s the advantage of doing that?
Sandy: It’s the best way to improve the health of the people who come
to Primary Care. Primary care is where people bring all the problems
that theydon’t know what to do about. A lot of times those problems,
even the problems that are clearly physical, are
related to the fact that they don’t take care of themselves. They are
depressed or they are anxious, or they drink too much, or they don’t eat
right, or don’t take their medicine, so they feel bad, so they hurt.
When people are hurting it tends to make them
more anxious or more depressed, or they drink more, or exercise less.
If the doctor says he/she can take care of the part that hurts but they
are going to send them to a mental health service or a substance abuse
service for their anxiety, or depression, or
drinking, a majority of the people don’t go. For them it doesn’t feel
like two separate things. It feels like one thing. It’s only when you
bring a person who can deal with anxiety and depression and alcohol use
problems into the primary care and put them
on a team with a doctor that the patient feels like he/she can get
their whole situation cared for.
It even costs less because if the person doesn’t get the
whole situation dealt with effectively, they tend to go other places
like emergency rooms to try and get enough care to relieve their various
Bob: I’m trying to imagine what that would be like in the doctor’s office. How would it work?
Sandy: Well, if you came because you had a pain or because it was
time for your physical, the doctor might talk to you about how your life
was going or give you a screening test that would take about 5 minutes.
The test would help pick up if you were having troubles with
depression or anxiety or drinking. And if any of thoseseemed to be a
part of the situation that you’re bringing, the doctor might call in a
psychologist or a clinical social worker or some
other person that they would probably call a behavioral specialist. The
doc might introduce you to the behavioral specialist and go see another
patient or two while the both of you talked. Just like primary care
doctors take care of everyday kinds of problems
after they make sure it’s nothing that’s going to kill you, behavioral
specialist would probably do the same. He/she would ask you a couple of
questions to be sure that you weren’t in a very serious or dangerous
situation but then they would focus on getting
you better as quickly as possible. They might work with you to find
something that you like to do everyday, which actually has been shown to
start improvement for people with depression, orthey might teach you
some breathing exercises that actually make a
difference with people with anxiety. When the doctor came back in the
behavioral specialist might make a recommendation to the doctor about
whether the doctor might consider prescribing you some medicine. You
might come back to see the behavioral specialist
a time or two to be sure that things are heading in the right
direction. But in the long run you just go back to working with your
doctor and the behavioral specialist would be somebody who would be
available if you ever needed them again.
Bob: That sounds terrific, sign me up!
Alexander Blount is Director
of the Center for Integrated Primary Care and Professor of Family Medicine and
Psychiatry at the University of Massachusetts Medical School in Worcester, MA. At UMass he has developed training programs in Primary Care
Behavioral Health and Integrated Care Management that have already trained 2000
people for the workforce needs of the transformation of healthcare. His books include Integrated Primary Care: The Future of
Medical and Mental Health Collaboration and Knowledge
Acquisition, written with James Brule’. He is Past President of the Collaborative
Family Healthcare Association, a national multidisciplinary organization
promoting the inclusion of mental health services in medical settings and he is
past-Editor of Families, Systems and