Primary-care provider reflections on research and training from special issue on ethical quandaries when delivering integrated primary care

摘要

As part of this special issue on ethics in integrated primary-care settings, my coeditors asked me to provide brief reflections on each article. We all believed including a physician perspective would encourage cross-discipline dialogue and produce an issue that models the medical team in the patient-centered medical home. Having practiced family medicine for over 20 years and worked in both a colocated model and for the last 6 years, in a fully integrated care setting with a behavioral health consultant (BHC; Robinson & Reiter, 2007), I can attest to the benefits of integrated care for my patients and myself, and to the unique ethical dilemmas of integrated settings as addressed in this issue. Collaboration in the context of a "learning community" leads to better patient care and helps build the "adaptive reserve" needed to weather our challenges in delivering quality primary care (Miller, Crabtree, Nutting, Stange, and Jaen, 2010). To best understand the context of my comments, you are encouraged to read the Introduction to this special issue of Families, Systems & Health, which describes the "four-box method" (Jonsen, Siegler, & Win-slade, 2010), a tool for sorting out and prioritizing truly ethical issues from other factors, such as communication and availability of resources that may be affecting clinical decision-making. Included below are my reflections for the articles on the final section of this special issue, Research and Training.