Technician, friend, detective, and healer: family physicians' responses to emotional distress

J Fam Pract. 2001 Oct;50(10):864-70.


Objective: We sought to develop a typology of physicians' responses to patients' expressed mental health needs to better understand the gap between idealized practice and actual care for emotional distress and mental health problems.

Study design: We used a multimethod comparative case study design of 18 family practices that included detailed descriptive field notes from direct observation of 1637 outpatient visits. An immersion/crystallization approach was used to explore physicians' responses to emotional distress and apparent mental health issues.

Population: A total of 379 outpatient encounters were reviewed from a purposeful sample of 13 family physicians from the 57 clinicians observed.

Outcomes measured: Descriptive field notes of outpatient visits were examined for emotional content and physicians' responses to emotional distress.

Results: Analyses revealed a 3-phase process by which physicians responded to emotional distress: recognition, triage, and management. The analyses also uncovered a 4-quadrant typology of management based on the physician's philosophy (biomedical vs holistic) and skill level (basic vs more advanced).

Conclusions: Physicians appear to manage mental health issues by using 1 of 4 approaches based on their philosophy and core set of skills. Physician education and practice improvement should be tailored to build on physicians' natural philosophical proclivity and psychosocial skills.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Affective Symptoms / therapy*
  • Clinical Competence
  • Family Practice* / organization & administration
  • Female
  • Humans
  • Male
  • Mental Disorders / therapy*
  • Mental Health Services / organization & administration
  • Midwestern United States
  • Office Visits
  • Physician's Role
  • Physician-Patient Relations*
  • Practice Patterns, Physicians'*