Family physician responses

Boundary clarification is a requirement to successful collaboration (McDaniel et al., 1992), particularly when multiple mental health providers participate in one case. Regardless of the degree one has earned, patients and family members may refer to all health care professionals as doctor and have skewed expectations about who is responsible for what. For example, patients commonly discuss medication with their nonprescribing therapist and occasionally solicit advice on how much medication to take, when to take it, and whether to discontinue its use. Similarly, patients report the progress of a therapy intervention with their psychiatrist or family physician. 

Once the family and the physician agree to use a pharmacological intervention to treat the child s disorder, the identified target symptoms should be reviewed and the medication options to treat these symptoms described. The prioritized problem list should be matched with appropriate interventions based on evidence from the research literature regarding the potential of the medication to benefit the target symptoms, as well as its side effects. The experience of the child or family members with other medication treatments, ease of administration, and length of time for treatment response should also be considered. 

Both therapy and medication compliance can improve when the family therapist and physician have a collaborative alliance with the family, not simply the patient, and can manage the varying responses of family members over time to the patient, the illness, and the medication. 

The responsibility of caring for a patient usually falls on members of the family. Thus, they are not simply uninvolved bystanders. For example, it is not unusual for family members to prompt the patient to make the initial appointment with the therapist or physician. Because of the stigma of mental illness and the patient s worries about burdening family members, the family may not be fully informed on the health status of the patient. This lack of knowledge may be related to conflictual relationships in the family and a patient s preference to keep family members uninformed. 

In the United States, the majority of mental health services are provided by nonmedical therapists. Likewise, the majority of prescriptions for psychotropic medications are written by family practice and primary care physicians (see figure 1-A). Thus, even though psychiatrists represent the branch of medicine that specializes in psychopharmacology, they are directly responsible for providing only a fraction of professional services to the mentally ill. Consequently it is becoming increasingly important for all mental health clinicians to have a basic familiarity with psychiatric medication treatment. 

A nurse practitioner does all of the things that registered nurses in hospitals or physicians offices do. In fact, most nurse practitioners (NPs) begin as nurses and, after a few years of experience, study to become a nurse practitioner. Nurse practitioners have some of the same responsibilities as physicians. NPs can do extensive diagnoses of disease, carry out medical tests, counsel families, and in some cases, prescribe medicine. They often have specialties, such as pediatrics, mental health, or geriatrics. For some families, the NP is the primary health care provider. 

Children respond to disasters based on their developmental stage, their level of exposure and the response of others around them (22). Physical injury, proximity to the disaster, witnessing injury and death of family members or other loved ones, the extent and duration of disruption of daily activities, parental reactions and family disruption all contribute to how children respond. Relevant developmental factors include cognitive, physical, educational and social development and experience. In addition, the emotional state of children and their families before the disaster help predict their response after. Therefore, primary care physicians who have provided continuous care for families, including emotional support, are well suited to help families, including children, to adjust following a disaster (22). 

Appropriate education depends on the degree of knowledge of the physician who cares for the patient, and is primarily responsible for educating the patient and/or family members about allergic diseases and/or asthma. Nurses,... 

Section (e)(2)(ii)(E) Nothing in this section precludes a physician, nurse, or other responsible health care personnel maintaining employee medical records from deleting from the requested medical records the identity of a family member, personal friend, or fellow employee who has provided confidential information concerning an employee s health status, and, under Analyses using exposure or medical records ... 

I was not involved in clinical research initially as a career. I was a medical records analyst/correspondent for a family practice health maintenance organization (HMO). A friend told me about the position, I applied, and here I am, nine years later. I am now responsible for large-scale respiratory studies within oncology, dealing with physician-initiated and industrial clinical trials. 

Managing Practitioner. The managing practitioner is the physician or other practitioner most directly responsible for the overall care of the patient while at The Health Care Organization. The managing practitioner, or the person delegated to assume this responsibility in the absence of the managing practitioner, has the primary caregiver relationship with the patient and family. 

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