The family physician and the psychologist together in primary care: an effort towards integration.

50% of requests brought to family physicians, though expressed as physical symptoms, often derive from relational/existential problems: seldom, however, is the physician in a condition to meet this demand adequately. Differentiation of models between medicine and psychology makes co-operation through referral to a psychologist quite problematic. Acceptance of psychological referral is in any case difficult, due to the social stigma that still surrounds contact with mental health operators. An experience implemented by the postgraduate Health Psychology School of the Rome University ‘Sapienza’, entails joint, direct co-operation between primary care physicians and psychologists during consultations. Such an arrangement allows access to a psychologist’s listening and intervention in the absence of any filter and without the need for a formal request on the patient’s part, so overcoming the fear of social stigma. In a small number of cases, more formal consultation with the psychologist is proposed. This setting allows exploration of the meaning of any complaint brought by patients in the context of the individual’s past and/or present relational situation, in a very early phase. The experience, beginning in 2000, has until now involved 18 psychologists for a period of 3 years each: it appeared as entirely feasible, though requiring several months for adaptation; patients have welcomed the presence of the psychologist and, took a broader approach in reporting their distress. In two cases where data were available, a substantial (17% and 14%) reduction of drug prescription on part of the physician was recorded. Illustrative clinical vignettes will be presented.