Dr. Chung recently presented a patient case on anxiety at our Mind Matters ECHO Behavioral Health Learning Collaborative. We recently caught up with Dr. Chung to learn more about his commitment to behavioral health to support his patients.

1.  Tell us a bit about yourself and your career path. What do you enjoy most about being a family physician?

I grew up in Michigan and went to school to become an engineer. During college I had many friends who were going to medical school so when the time came to take MCATs and apply, I took a chance. I was in the Air Force ROTC so if I did not get into graduate school or medical school, I would have to enter the Air Force as an engineer. Luckily I made it. 

My medical school, Wayne State University in Detroit, was focused on primary care. Many of my rotations were in family doctors' offices where the doctors knew entire families and could tell the stories of kids who grew up from delivery all the way through college.

I liked the idea of being able to see a variety of patients, make a connection, perform procedures, and to see those patients over time.

I eventually worked in the Air Force as a family doctor and then in a large group practice and then a practice that served the underserved patients in New York.  Once I got to know how the business of medicine worked, I opened my practice and formed a group of my own.  

It seems like nothing in New York can ever be perfect, but this is the closest I’ve come to being able to really practice family medicine.

2. You have presented at two Mind Matters ECHO sessions. What, if anything, was valuable about the feedback you received?

The biggest take away for me was that there is never one definitive answer. Mental health issues are never clear or straightforward.  A simple and clear solution never seems to be possible. But, what you can learn is the "approach" to a situation and the various techniques to help a patient move forward.

3. At the last session on anxiety, your question reflected on the role of a family physician in managing behavioral health needs. You wondered whether you, as a family physician, are the appropriate provider to manage a patient with chronic anxiety, depression, and a complex history, or is a family physician the most appropriate person to manage this patient. Your question underscores the unique strengths, challenges, and opportunity that primary care providers face with managing the behavioral health needs of their patients. Tell us a bit about what made you wonder about this with this patient, and whether this is a question that comes up for you for other patients. 

Most of the time when I encounter a patient that is anxious or depressed I feel that the chance they will receive help from a therapist or psychiatrist is close to zero. Whether it is cost, time, insurance network.…..whatever…..at that moment, I’m on my own.  This happens every day.

Since they’re never going to see a specialist, I feel that it is important for family doctors to have a variety of mental health treatment skills and the confidence to try them over time.  Together with the connection we have with our patients it may be enough to bring them through their current problem.

4. What do you think are some of the strengths primary care providers have in managing behavioral health care needs?

Probably the biggest advantage primary doctors have is that they take insurance.  Many psychologists or psychiatrists do not accept insurance so patients cannot afford a visit.  

But, when they are in the office for their physical, a sick visit or a chronic problem there is an opportunity to engage them regarding their mental health issue.  Having a good approach and the confidence to follow through can help many patients get through their problem.

Of course is important to learn how to code for these extra services that you are providing so that you can be paid for the time spent managing behavioral health.

5. What do you think are some of the biggest barriers PCPs face in managing behavioral health issues in their practice?

Time and knowledge.

Family doctors need appropriate training to feel comfortable treating behavioral health issues in a time efficient manner.

6. Do you have any outstanding concerns about managing the patient you presented?

No.  She is doing well seeing a therapist intermittently while I provide her medication.

7. Was the feedback you received at Mind Matters ECHO regarding this patient helpful to you? If so, in what way?

It is always helpful to hear what other doctors would do in the same situation. As I said above a single clear answer is not always available.  It helps to hear the various approaches so you have an idea what to do if the same situation arises again.

8. What advice would you offer other family physicians who may be wondering about their role in managing behavioral health needs in primary care?

The reason I decided to participate in the ECHO program was to join a network of providers who focus on providing behavioral health care.  Just like hypertension and diabetes, “it’s out there.” Sharing strategies and techniques with other colleagues is the best way to become better at it.

9. Finally, where would you like to healthcare shift as a system in terms of managing behavioral health needs? 

If I could refer a patient to a behavioral health specialist just like I refer a patient to a dermatologist, it would be great.