Abstracts

Rationale: Medical counseling by a trained professional is a unique therapy for individuals who suffer with a medical diagnosis of epilepsy and the personally destructive stigma it frequently carries in a social context. Medical counseling fosters healing and wellness and can be markedly effective during routine medical care for those who endure chronic illness and medical issues. Such an intervention measured against brief, time-limited discussions with physicians would confer substantial benefit to individuals at increased risk of behavioral, emotional, and other health problems. We examined factors that influence whether, why, and how medical counseling by a trained professional can be integrated effectively as a primary function of routine medical care. Methods: We interviewed 41 individuals in health care (14 clinicians, 3 PAs, 5 RNs, 3 PNs, 8 social workers, 3 HMO CEOs, 7 consumers) in the greater New York City area via questionnaire and telephone and explored specific questions in detail. We also convened 31 individuals (physicians, health educators, PAs, psychologists, specialty care providers, nutritionists, PNs, and social workers) from stakeholder provider groups for a series of 7 discussion forums. Each forum promoted participants individual and collective experience as to what works, what doesn t, and what would accelerate acceptance of this intervention. All participants attended each forum. Results: The data yielded converging insights about integrating professional medical counseling as a primary function of routine medical care. 1. Clinicians and researchers are seeking a mutual language to translate medical and behavioral science to interventions correlated to accepted medical protocol. 2. The need for medical counseling in routine medical care has been dwarfed by turmoil in health care delivery. 3. For a unified voice, individuals must be advised of the merit of medical counseling in routine medical care. 4. Medical providers respond to trusted colleagues for new evidence. 5. Physicians foresight, appropriate tools, and system supports encourage positive change to integrate medical counseling in routine medical care. 6. Stakeholders need models and tools to distinguish services. 7. Clinicians want means to monitor services and respond to incentives.Conclusions: Those who suffer with medical issues of epilepsy and other chronic illness can benefit from medical counseling integrated as a primary function of routine medical care. The challenge is to craft a targeted intervention executed by a trained professional with adequate time for discussion rather than time-limited discussions with physicians that may compromise clinical management. To change routine health care delivery to incorporate medical counseling we must acknowledge the significant influence medical counseling has to health and to patient education, the trust patients bestow on their physicians, and multifaceted contributions of health care stakeholders. These issues must be acknowledged and synchronized with diverse approaches to integrate medical counseling and reform health care delivery to benefit the individual.