Psychologists in Primary Care



Dr. Suzanne Engelman

California Licensed Psychologist PSY7977
Board Certified in Biofeedback
Certified Thanatologist
Certified Animal Assisted Therapist

LOCATION:
30131 Town Center Drive

Suite # 268

Laguna Niguel, CA 92677

Office Phone:  (949) 460-4908 
FAX:  (949) 248-0421
Confidential email: srephd@hushmail.com
Psychologists in Primary Care The American health care system is undergoing tremendous transformation. The great value of primary care lies in its potential to comprehensively treat the whole person. With a majority of people seeking and receiving care for behavioral and substance abuse issues within the primary care setting, psychologists are in a strong position to offer their expertise in helping primary care teams provide a more integrated delivery of health care and better treatment outcomes.

Psychosocial Issues Affecting Chronic Disease Management

Patients with acute or  chronic illness such as asthma, depression, chronic obstructive pulmonary disease, diabetes, heart disease and hypertension need help to learn how to: cope with the intense emotions related to their illness; change poor health behaviors; and manage the effect of their health problems in their lives. Research shows approximately 95 percent of variations in chronic disease outcomes, result from patient lifestyle and poor disease management behaviors, and emotional distress is commonly underlying these behaviors.  Psychologists in primary care are trained to help sort out the psychosocial issues, such as personal beliefs, personality traits, family and cultural contexts, stress reactions,  and depression,  which are crucial to positive patient treatment outcomes.

Integrating Psychologists and Primary Care

There are numerous models of how behavioral health and primary care may be integrated, varying from distinctly separate and independent primary and behavioral health facilities, to models that locate psychologists and physicians in the same office or on the same treatment team in an inpatient setting.  Closer integration offers the advantages of psychologists being able to  care for patients at the time of the medical visit, including patient assessment to promote positive health behavior changes (such as compliance to medication regimine), consultations with physicians and other team members, as well as working with family members who are present at the patient’s primary care visit.

Studies show that comprehensive approaches combining behavioral health interventions with biomedical models result in improved care, including increased patient satisfaction, use of fewer medications, less use of the emergency department and hospital, and reductions in overall health care costs.

Psychologists and Palliative Care

In the primary care setting, the difficult transition to palliative care may be necessary as acute and chronic health conditions advance, suffering and pain intensify, and dying becomes imminent. Since the goal of palliative care is to alleviate physical, psychosocial and spiritual suffering along the illness trajectory, the psychologist working in primary care is in a unique position to offer support to the patient and family by helping them determine how to maximize the quality of life. Most importantly, in this clinical work, is the therapeutic relationship — a kind of  “being present with” patients who are struggling with diminished autonomy, spiritual upheaval,  unclear goals for further care, and facing the dying process with dignity and meaning. Work may be done at the hospital bedside, in the infusion room during chemotherapy, while accompanying an anxious patient through radiology or in the private practice consultation room.

Whether the medical problems are cancer, heart disease, chronic pain, headaches or medically unexplained conditions, the primary care psychologist holds expertise in treating underlying attitudes, emotions and reactions to stress that may exacerbate symptoms. Working from a strong psycho-educational framework helps people understand the interactions of their emotions, the autonomic nervous system and their physical symptoms, as well as learn more productive ways of coping with stress and transform physical symptoms that have a psycho-physiologic basis.  Biofeedback, hypnosis, progressive relaxation, visualizations, meditation, diaphragmatic breathing, dream work and other tools may be used to facilitate self-awareness and assist the person to self-regulate stress responses, decrease physical symptoms and pain, and lower medication usage.

   

REFERENCES

Fisher, L., & Dickinson, W.P. (2014). Psychology and primary care. American Psychologist, 69(4), 355-363. doi: 10.1037/a0036101

Gonzalez, J.S., Fisher, L., & Polonsky, W.J. (2011) Depression in diabetes:  Have we been missing something important?  Diabetes Care, 34, 236-239. doi: 10.233/dc10-1970

Kessler, R.C., Berglund, P., Demler, O., Jin, R., Merikangas, K.R., & Walters, E.E. (2005). Lifetime prevalence and age-of onset distribution of DSM-IV disorders in the National Comorbidity Survey Replication.  Archives of General Psychiatry, 62(6), 593-602. doi: 10. 1001/archpsyc.62.6.593

Schoen, C., Osborn, R., Squires, D., Doty, M., Pierson,R., & Applebaum, S. (2011). New 2011 survey of patients with complex care needs in eleven countries finds that care is often poorly coordinated. Health Affairs, 30(12), 2437-2448. doi: 10.1377/hlthaff.2011.0923.

Solberg, L.I.(2011). How can we remodel practices into medical homes without a blueprint or a bank account? Journal of Ambulatory Care Management, 34(1), 3-9.doi:10.1097/MLR.0b013e3181dbea62.

Tuerk, P.W., Mueller, M., & Egede, L.E. (2008) Estimating physician effects on glycemic control in the treatment of diabetes:  Methods, effect sizes, and implications for treatment policy. Diabetes Care, 31, 869-873. doi:10.2337/dc07-1662

BIOGRAPHICAL SKETCH Suzanne R. Engelman, PhD, BCB, FT is a licensed health and clinical psychologist with private practice offices in Orange and Laguna Niguel, Calif. Dr. Engelman specializes in working with patients and their families struggling with coping with serious medical illnesses such as cancer, death, dying and bereavement, medically unexplained symptoms and stress-related disorders. She holds a Fellow Certification in Thanatology; Board Certification, Associate Fellow level in Biofeedback (thermal, heart rate variability, respiratory, electrodermal, EMG); and Certification as an Animal Assisted Therapist.    Dr. Engelman is on the medical staff at St. Joseph Hospital and is the author of numerous articles and editor of Life Threatening Illness: Mind/Body Approaches. More information about Dr. Engelman can be found on her website: www.healthpsychologynow.com or by calling (949) 460-4908.  Dr. Engelman is a preferred provider for SJHAP and MHAP medical groups.

In her free time, Dr. Engelman likes to hike, meditate and spend time with her family.