Hope

Ruth Kannai; Aya Alon

doi:10.1370/afm.1968

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Re:Family medicine as true psychiatry
Donald Nease

Published on: 23 September 2016
Family medicine as true psychiatry
John Launer

Published on: 22 September 2016

Published on: (23 September 2016)
Page navigation anchor for Re:Family medicine as true psychiatry
Re:Family medicine as true psychiatry
Donald Nease, Associate Professor
I wish to commend the authors of this reflective paper and echo Dr. Launer's sentiment about this story being evocative of Family Medicine/General Practice being identified by Michael Balint as the home for true psychiatry. However, I would add that Balint's statement identifies the potential, not necessarily the reality. DeGruy and Green speak to this in their commentary in this issue, however, I don't believe they qui...
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I wish to commend the authors of this reflective paper and echo Dr. Launer's sentiment about this story being evocative of Family Medicine/General Practice being identified by Michael Balint as the home for true psychiatry. However, I would add that Balint's statement identifies the potential, not necessarily the reality. DeGruy and Green speak to this in their commentary in this issue, however, I don't believe they quite go far enough in their admonition for Family Medicine to reclaim this important territory. From my vantage point, this reclamation depends on the family physician's emotional competency to wade into deep waters. This emotional competency, wielded in the exam or consultation room, was at the core of what Michael Balint sought to bring to our discipline. It's not enough to merely advocate for Family Medicine's return to this space, we must actively equip ourselves for the emotional work.
As our residency program directors struggle to meet the increasing curricular demands for technical competency, we must acknowledge and fight for the curricular space that trains family doctors to recognize the importance of their own emotional receptors and how go beyond being overwhelmed by the emotional data to actually use that emotional data in a therapeutic manner. Balint groups are a method for that training. Diaz, et. al. have documented the dilution and disappearance of Balint groups from our residencies.(1)
If we fail as a discipline to adequately equip ourselves in this space, we may cling to fantasies that EHR's, payment mechanisms, lack of behavioral health colleagues caused us to cede this territory. I will, however, cling to my own belief that Family Medicine lost this ground because we failed to preserve a place for emotional competency in our training.
1. Diaz VA, Chessman A, Johnson AH, Brock CD, Gavin JK. Balint groups in family medicine residency programs: a follow-up study from 1990--2010. Fam Med. 2015;47(5):367-372.
Competing interests: I am President of the International Balint Federation.
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Competing Interests: None declared.
Published on: (22 September 2016)
Page navigation anchor for Family medicine as true psychiatry
Family medicine as true psychiatry
John Launer, Associate Dean
Ruth Kannai's beautifully written piece reminds me of Michael Balint's view that family physicians were able to practise psychiatry in a unique way - one that was already disappearing in his time and has now almost completely vanished. It is longitudinal over many years, and encompasses both the family and the individual. It takes diagnosis, risk and biology seriously, but doesn't let any of these imprison the doctor or h...
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Ruth Kannai's beautifully written piece reminds me of Michael Balint's view that family physicians were able to practise psychiatry in a unique way - one that was already disappearing in his time and has now almost completely vanished. It is longitudinal over many years, and encompasses both the family and the individual. It takes diagnosis, risk and biology seriously, but doesn't let any of these imprison the doctor or her patient. It permits uncertainty, dialogue, and the sustenance of hope even in continual adversity. This moving narrative is the definitive answer to the question: "What exactly is it that GPs do with their mental health patients, apart from giving drugs?"
Competing interests: Ruth Kannai is a colleague I have met on a number of occasions on teaching visits to Israel
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Competing Interests: None declared.