title: Technician, friend, detective, and healer: family physicians' responses to emotional distress.
abstract: 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.
  
  
  METHODS
  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.
  
  
  METHODS
  A total of 379 outpatient encounters were reviewed from a purposeful sample of 13 family physicians from the 57 clinicians observed.
  
  
  METHODS
  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.
authors.affiliation: University of Nebraska Medical Center, Department of Family Medicine, PO Box 983075, Omaha, NE 68198-3075, USA. wdrobins@unmc.edu
authors.forename: W D
authors.initials: WD
authors.lastname: Robinson
authors.forename: L A
authors.initials: LA
authors.lastname: Priest
authors.forename: J L
authors.initials: JL
authors.lastname: Susman
authors.forename: J
authors.initials: J
authors.lastname: Rouse
authors.forename: B F
authors.initials: BF
authors.lastname: Crabtree
mesh_terms: D000328:Adult; D000342:Affective Symptoms / Q000628:therapy*; D002983:Clinical Competence; D005194:Family Practice / Q000458:organization & administration; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000628:therapy*; D008605:Mental Health Services / Q000458:organization & administration; D015146:Midwestern United States; D009819:Office Visits; D010819:Physician's Role; D010817:Physician-Patient Relations; D010818:Practice Patterns, Physicians'