| In order to hear first hand accounts of what is happening
in primary care settings around the country, Facing Fear Together conducted
fourteen focus groups. Family physicians, pediatricians, nurse practitioners,
psychiatrists, psychologists, social workers, internists and obstetricians-gynecologists
participated.
Locations were selected strategically and included:
Chicago, IL
Fargo, ND
Pittsburgh, PA
New York City (two groups)
Washington DC (two groups)
Seattle, WA |
Miami, FL
Albuquerque, NM
Oklahoma City, OK
Birmingham, AL
Los Angeles, CA |
Each group probed the occurrence of new or increased health
concerns following September 11th and the ongoing threat of homeland terrorism.
Most agreed that anxiety has heightened around the country, but the emotional
responses intensify with physical proximity to the events and with a past
history of trauma or exposure to other disasters such as floods, coal mine
disasters, and impending deployment to war sites. Participants universally
reflected on their own responses and expressed concern about their preparation
to handle a massive terrorist or bioterrorist event.
Participants were enthusiastic about a model of collaborative
primary care where physicians, nurses and mental health providers work
as a team on behalf of patients and families. They described difficulties
in accessing mental health care for their patients, especially for children
where a severe crisis seems to exist.
Emerging from the fourteen groups was a keen sense that
the emotional impact of September 11 is not entirely resolved and anticipation
of difficult times ahead weighs on primary health care doctors, nurses,
and mental health professionals.
Quotes from Focus Group Participants:
SOMATIC SYMPTOMS
“It was almost immediate. There
were some people who were hospitalized in-patient just from witnessing
it while they were waiting for their routine appointment in their primary
care clinic that just immediately started flashing back. It was almost
instantaneous.”
Primary Care Provider in New York City
“{We are seeing} some of the
same things we had in ’97 when we had the flood. We saw lots of anxiety
and lots of somatic illness. So I think it depends on how close you are
to that disaster, how real that disaster was.”
Primary Care Provider in Fargo, North Dakota
“There
was no medical reason for them to have this problem. But, if all of a sudden,
you see this abundance of chest pain or neck pain or irritable bowel syndrome,
what is it from? Where did this come from? It came from what we just experienced
in this country. We all experience things, whether it’s a patient
or us.”
Primary Care Provider in Detroit
“What
we saw was an increase in our urgent care department. We are on the west
side of 97th street. We had a lot of upper respiratory complaints coming
in. With that we had patients who also had an inability to sleep, not wanting
to go back outside. Some patients were symptomatic and others just the
fear of becoming symptomatic.”
Primary Care Provider in New York City
“Lots
and lots of kids are showing up in the nurse’s office with headaches
and earaches and just in general ‘I don’t feel well.’”
Nurse practitioner in Washington, DC
“I have
a lady who doesn’t sleep. I said why don’t you sleep? She says,
“ I don’t know.” I said when did it begin? “Probably
just after my son was killed.”
Primary Care Provider in Washington, DC
“The
PTSD [post traumatic stress disorder] that I have seen is from years ago
where soldiers from Vietnam, not returning from Vietnam but ten years after
Vietnam, and fifteen years after Vietnam – it showed up in alcoholism
patterns and spousal abuse patterns and things of that nature, It wasn’t
just the year or the month after, it was a long time after.”
Psychologist in Washington, DC
SPECIAL POPULATIONS
Children
“I can
remember one specific story of my colleague’s patient – a 7
year old girl who came in who was not sleeping, who was not eating and
would not leave the side of her parents. She had to be in the presence
of one parent all the time. She [my colleague] asked her why is this? What
is happening? Why are you feeling this way? She [the girl] said, “
I don’t want to sleep, because I don’t know how long we are
going to be able to live, so I really don’t want to spend anytime
sleeping.”
Primary Care Provider in New York City
“We
had several students who lost family members in the Pentagon, and we had
several students who lost uncles, brothers, cousins in the world Trade
Center. They were the children who had more trouble when the sniper attacks
started. They were the ones who couldn’t sleep, started to do poorly
in school, and it was the situational stress once again just fed into the
stress that they had before.”
Primary Care Provider in Washington, DC
“The
mental health issue…has become critical, since it [terrorism] probably
or possibly can happen again. What precautions can we take to minimize
risk? We were overwhelmed with emotional issues from both sides, the children’s
fears and the parents’ concerns.”
Same New York pediatrician
Immigrants
“I think
for me the biggest impact was on my Kurdish population. It took the majority
of them 2-3 months to feel safe to come out of their home. A few of them
said they had feared for their lives to just step out the door.”
Primary Care Provider in Fargo, North Dakota
Holocaust Survivors
“I have a number of concentration
camp survivors that live in the Brooklyn area with very good eyesight of
what was happening down there. Not only the smoke, but…I don’t
know exactly what to say, but the aroma was so reminiscent for these people
of what the camps were like, of what the kilns and fires were like, that
they were really hard hit.”
Primary Care Provider in New
York City
PRIMARY CARE PROVIDERS AS MENTAL HEALTH PROVIDERS
“My
wife is an internist. She says her medical visits are about 80% psychiatric
and she is a first rate psychiatrist by now.”
Psychiatrist in New York
“In
my case I would say that 40-60% of the patients I see on a daily basis
have some psychological issue. They come in for everything else, but there
is an issue.”
Primary Care Provider in New York City
“Primary
care physicians really felt horribly traumatized--some primarily, some
secondarily. And we also felt just terribly under prepared, unequipped
to address the type of acute anxiety and strain that the patient population
was facing.”
Mental Health Care Provider in Seattle
COLLABORATIVE CARE
“In rural
communities where we work, we have to send our people a long way for a
mental health consult. It would extremely valuable to have collaborative
care.”
Primary Care Provider in Birmingham, Alabama
“It’s
not that 9/11 caused this. 9/11 tore the top off it [need for pediatric
mental health services]…I can no longer even call someone I know
and say “ I need to have a favor.” There are no more favors
out there.”
Pediatrician 50 miles outside NYC
BARRIERS TO COLLABORATIVE CARE
“Our
reimbursement system, our insurance system, reimburses for physical complaints
and does not pay primary care providers for emotional complaints. If you
come in and complain you have a sore throat or you have a cough or you
have chest pain, that is fine. But when the diagnosis is not chest pain
but it becomes emotional, you run a real problem.“
Primary Care Provider in New York City
“If
the insurance carriers would put more emphasis on mental health, there
would be a lot less [physical] problems. They could save a lot of money,
because [the problems] eventually get to the home and family, and the dysfunction
is propagated.”
Primary Care Provider in Fargo, North Dakota
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