As an IBHC, what is a typical day like for you?
A typical day as an IBHC is fast-paced and full of variety. I work in an internal medicine clinic, so most of my patients are older with multiple medical problems. On any given day, I will see a mix of new and established patients in brief (20-30 minute) appointments. Problem areas range from mental health issues and conditions such as depression and anxiety, to adverse health behaviors such as tobacco use or alcohol misuse, to chronic medical problems like fibromyalgia, diabetes and obesity. I have frequent discussions with patients’ primary care managers to help ensure an effective team approach to care.
What do you like most about being an IBHC?
I enjoy working as part of an interdisciplinary primary care team. I learn a tremendous amount about management of various medical conditions from the primary care providers, and I believe my input regarding behavioral health aspects of patients’ conditions adds value to the care provided. I also appreciate being able to work with such a wide range of patients and presenting problems. I’m able to provide services focused on prevention and early intervention, as well as care for patients with more significant medical or mental health diagnoses. Every day is different from the next.
As an IBHC, what has been a challenge that you've had and what have you done to overcome it?
Documenting patient care in the medical record in a manner consistent with the primary care behavioral health model of service delivery was a challenge initially. I found it difficult to transition from writing more lengthy progress notes to a briefer style of documentation that would be useful for other members of the primary care team. To help make this shift, I consulted with other IBHCs, looked at sample documentation, and shifted to completing much of my documentation during the patient appointment itself (rather than waiting until the end of the appointment or the end of the day). With practice, documenting efficiently became much easier over time.
From a multi-disciplinary perspective, what can a PCM (or PCMH team) do to make you more effective in facilitating care for patients?
The most important action for PCMs to take to facilitate effective integrated care is to refer a wide range of patients. Most patients seen in PCMH could benefit from consultation with an IBHC, whether to improve a health behavior (e.g., exercising more), adhere to the PCM’s recommendations for managing a chronic condition, or develop and use strategies for improving behavioral health conditions. PCMs who only refer patients at the most severe end of the spectrum are not taking advantage of the wide range of services that could be provided.