title: Primary care physician perceptions on caring for complex patients with medical and mental illness.
abstract: BACKGROUND
  Mental illness is common and associated with poor outcomes for co-occurring medical illness. Since primary care physicians manage the treatment of complex patients with both mental and medical illnesses, their perspectives on the care of these patients is vital to improving clinical outcomes.
  
  
  OBJECTIVE
  To examine physician perceptions of patient, physician and system factors that affect the care of complex patients with mental and medical illness.
  
  
  METHODS
  Inductive, participatory, team-based qualitative analysis of transcripts of in-depth semi-structured interviews.
  
  
  METHODS
  Fifteen internal medicine physicians from two university primary care clinics and three community health clinics.
  
  
  RESULTS
  Participant characteristics were balanced in terms of years in practice, practice site, and gender. Physicians identified contributing factors to the complexity of patient care within the domains of patient, physician and system factors. Physicians identified 1) type of mental illness, 2) acuity of mental illness, and 3) communication styles of individual patients as the principal patient characteristics that affected care. Physicians expressed concern regarding their own lack of medical knowledge, clinical experience, and communication skills in treating mental illness. Further, they discussed tensions between professionalism and emotional responses to patients. Participants expressed great frustration with the healthcare system centered on: 1) lack of mental health resources, 2) fragmentation of care, 3) clinic procedures, and 4) the national healthcare system.
  
  
  CONCLUSIONS
  Physicians in this study made a compelling case for increased training in the treatment of mental illness and improvements in the delivery of mental health care. Participants expressed a strong desire for increased integration of care through collaboration between primary care providers and mental health specialists. This approach could improve both comfort in treating mental illness and the delivery of care for complex patients.
authors.affiliation: Division of General Internal Medicine, Department of Medicine, University of Colorado, Academic Office 1; Mailstop B180; 12631 East 17th Ave., Aurora, CO 80045, USA. Danielle.loeb@ucdenver.edu
authors.forename: Danielle F
authors.initials: DF
authors.lastname: Loeb
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Bayliss
authors.forename: Ingrid A
authors.initials: IA
authors.lastname: Binswanger
authors.forename: Carey
authors.initials: C
authors.lastname: Candrian
authors.forename: Frank V
authors.initials: FV
authors.lastname: deGruy
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis* / Q000523:psychology / Q000628:therapy*; D008875:Middle Aged; D010465:Perception; D010817:Physician-Patient Relations; D058007:Physicians, Primary Care / Q000523:psychology; D011795:Surveys and Questionnaires