The Medical-Psychiatric Coordinating Physician (MPCP) model of care addresses the intimidating challenges posed by “complex cases.” These are cases with simultaneous and interrelated (co-morbid) systemic medical and psychiatric illnesses, as well as thorny systems-based management requirements. Most often these patients also have significant psychological and psychosocial difficulties. In spite of their complexities, these cases are often inadequately managed as solely “systemic medical” conditions (e.g., “diabetes”) or “psychiatric” (e.g.,” depression”), or are overly simplified when treating physicians operate from within specialty “silos.”
It stands to reason that these patients are best understood as multiply afflicted (e.g., “diabetes with co-morbid depression and work-related problems”) with complexities that are synergistically linked and add exponentially to the patient’s suffering. For these situations, proper attention to all aspects of the case is required to assure acceptable outcomes. Much of medical practice currently endeavors to follow an integrated biopsychosocial approach and will increasingly do so in the future. Supplementary psychiatric training to enable primary care providers (PCPs) to practice in an integrated way will continue to be an important imperative if we are to maintain a system of medical care delivery that appropriately empowers PCPs to practice optimally. However, as most PCPs will readily acknowledge, even with such a supported PCP model there are many patients, our “complex” cases, who would preferentially be served by an model such as the MPCP that emphasizes dedicated, comprehensive care.
For these complex, high maintenance patients, we propose a comprehensive approach led by a physician, the MPCP. That physician should either be a psychiatrist, or, together with training in general medicine, have substantial additional training in psychiatry. The physician would lead a multidisciplinary treatment team and be fully accountable for treatment outcomes. PCPs would likely be a major referral source for these treatment teams. An existing analogy is physician-led collaboration involving multiple providers for disease-specific treatment services in cancer and transplant centers.
The MPCP would not “replace” PCPs or specialty physicians. MPCPs, instead, would work hand in hand with PCPs as active collaborators and for managing referrals. MPCP-led teams would likely make broader use of mental health interventions (e.g., psychometric testing, psychotherapy, family-focused interventions) than is currently the case in most primary care environments. The MPCP-led treatment model operating in this way could be viewed as disease management for complex patients. As such, this model may qualify as a medical subspecialty in its own right, and additionally lead to new professional opportunities for mental health professionals outside the boundaries of the traditional mental health system.
Our new book, Comprehensive Care for Complex Patients: The Medical-Psychiatric Coordinating Physician Model, offers a rich source of information about the MPCP method of care. The book is replete with detailed case examples illustrating the challenge posed to the clinician and, in fact, the medical system, by clinically complex patients. The book represents 20 years of intense clinically-focused work dedicated to solving the dilemma posed by this problematic group of patients.