Factors involved in successful psychotherapy referral in rural primary care.

Many primary care patients are identified as needing psychotherapy. Often family physicians choose to refer these patients for comprehensive treatment, yet psychotherapy referrals are traditionally difficult to transact successfully in comparison with referrals for other biomedical complaints. Previous reports have been published on the beliefs held by family physicians and psychologists regarding factors that affect the success of a referral. This follow-up study reviewed 138 referrals from rural family physicians to psychotherapists. Fifty-nine percent of the referrals were considered successful by the family physicians and 73% by the patients. Successful psychotherapy referral, as evaluated by physicians, was related to psychotherapist-initiated post-referral communication with the referring physician. There was no relationship between success of referral outcome and the number of preparatory (or follow-up) visits with the physician, physician's knowledge about the psychotherapy process, patient economic status, or insurance coverage. However, attending more than one therapy session was associated with the number of physician visits prior to referral, distance to the therapist's office, and referral by a physician who included counseling in his or her practice. Findings indicate that when physicians are kept informed about patients' treatment, they are more likely to evaluate the treatments as beneficial.

The Family Medicine Game: using humor to teach residents about endings.

Graduation and the emotional process of termination are developmental milestones in the family practice resident's training. This article describes one example of a behavioral sciences curriculum, "The Family Medicine Game," which facilitates this process through the use of humor. The Family Medicine Game aims to kill two educational birds with one stone. First, a process for negotiating developmental milestones is actually modeled, emphasizing mutual sharing of feelings with significant others and ritual ceremony to punctuate experience. Second, the vehicle of humor, with its intrinsic palliative qualities, affords the expression of vulnerable affect within the milieu of a darned good time.