Clin Practice

Clin Practice

Question 1: Discuss possible benefits and costs to both the client and yourself of working within a multi disciplinary team setting or with a primary care physician or as a sole practitioner.

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There are several advantages to working with a multi-disciplinary team. In being part of multi-disciplinary team with members for both medical care and medical counseling, patients are more assured that they are being given more comprehensive care, that equitably considers physical, mental, social, and emotional facets. It seems to make greater sense to leverage on the skills of many for the ultimate benefit of the patient. However, this would not be possible if the counselor does not have a firm belief that both medical and counseling skills are imperative in achieving full and authentic healing in the patient. Moreover, the partnership with a primary care physician or a multi-disciplinary team will allow a value-added role and constant involvement of the patient’s significant others. Such involvement and show of concern is expected to expedite his full recovery.

In being a sole practitioner, the counselor is limited to helping the patient and his loved ones adjust to a disease or condition through psychotherapeutic methods and skills. His primary strength is being able to help the patient undertake a smooth psychological adjustment to his condition. However, the treatment of the patient would not be holistic or complete –not without the expertise of a medical team and allied health professionals who are expected to be equally involved in the healing process. It has also been noted that awareness of the interface between the physician and the medical counselor in itself offers much consolation, knowing that a comprehensive approach is carried out towards one goal of healing and full recovery.

One other advantage of partnering with a multi-disciplinary team is the synergy that transpires in the process. For example, when the counselor observes some psychological dysfunction in the patient, he may give feedback to the medical practitioner so that he may incorporate it into his future treatment plans. Likewise, if the doctor or medical allied professional notices some physical malfunction or novel medical condition which might have an effect on the patient psychologically, then he may give feedback to the medical counselor who then tailor fits his therapies based on such new input. Another noteworthy advantage is the possibility of the counselor assisting the medical practitioner in conveying life-changing medical conditions or diseases to patients – in such a way that it is not too psychologically damaging or threatening. The medical counselor has a critical role in educating not only the patient, but also his medical doctor, the allied medical professionals attending to him, and significant others. These efforts are done in the hope of helping the patient to smoothly adapt and cope with his medical condition – all with the synergized efforts of those around him.

Logically, if the counselor chooses to work with a multidisciplinary team or at least with a primary care physician, the latter will be able to bring to the table his expertise in disease and the apt treatment for such disease. They may be able to help the medical counselor by constantly updating him of the physical and mental status of the patient and changes that occur in both facets. Because he has profound knowledge of the medical institution, and the parties that are best tapped for particular patient issues, he may be able to give advice to the medical counselor – for optimized patient benefit. Another benefit of the strong partnership between physician and counselor is the smoother process of acceptance of the patient, having accepted the involvement of the psychotherapist early on. When this component is added on too late in the process, it tends to create a stigma within the patient and may hamper healing. The active communication and exchange of feedback between the two partners will spell ultimate benefit for the patient under their joint care. These are some considerations that a counselor ought to seriously make in assessing whether or not a partnership with a primary care physician or a multi-disciplinary team would be worth his while.

Question 2: Fictitious Case History: For the last 4 months, you have been working with a client who has been diagnosed with a chronic and degenerative medical disorder. (You may choose any medical condition from the 9 major diseases covered earlier.) You used the MCC model and dealt with the issues of loss. You were also mindful of the developmental stage of the client and the importance of meeting these needs.

You are to write up a presentation of your experience with this client as if you were going to make a presentation to fellow colleagues of this course.

I have had the chance of admitting a 57 year old Latino patient with diabetes milletus. Being maxed out on oral treatments, the patient has started to undergo frequent dialysis sessions. The geriatric stage of the patient, the severity of his disease, his financial constraints, and family concerns combined have caused him depression, the symptoms of which he has exhibited of late. I made a decisive effort to use the MCC as a framework for his treatment so that recovery may be achieved more effectively and quickly.

As a counselor, I thought it prudent to partner with a primary care physician that specializes in diabetes to be able to expedite the recovery of my patient. Naturally, for the physician to agree with the partnership, I should be able to convince him of MCC as an apt perspective or approach to diabetes care. Because the physician whom I have approached also believes in partnership, I did not have a difficult time in soliciting commitment from him. I have also offered the idea of institutionalizing the practice in the hospital. I have taken the initiative to know more about the health care setting itself, the patient’s medical condition: symptoms, major impacts, typical course, treatment, and self-care regimens and the details of his pathway through the medical system.

Next, I took it as my responsibility to be keenly aware of the structures, preferences and norms of the medical institution and its key players. Knowledge of these and being accustomed to the institution’s ways is very important and may be indispensable in working smoothly and productively with my new partners. Because the institution upholds helping members of marginalized communities, I did not have difficulty convincing them that the treatment of this patient is worth partnering on. I have also realized the norms that they comply with are no different from most medical institutions’.  I have also realized that the nurses are most open to partnership

Being attuned to the needs and interests of the health care institution will enable the counselor to identify ways to be useful—that is, for example, which hospital departments were most receptive to the idea of partnering with a counselor for more effectual treatment and recovery of a patient. The department of the primary care physician was likewise very receptive to the idea. In the course of the patient’s treatment, I had ensured constant communication with all the parties involved in his healing process – the physician, his nurses, and his loved ones. All parties have been coached on how to empathize with him and how he can be best assisted. I have also solicited medical data from them to be able to dovetail my psychotherapy sessions with him. The collaboration proved to be a success. In about 6 months’ time of simultaneous medical treatment and counseling, he has adapted well to the condition. Because of the success of such partnership, we are thinking of institutionalizing such a program for patient groups with debilitating diseases.


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