Foreword| Volume 50, ISSUE 1, Pxiii-xiv, March 2023

We Are Here for You

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      Joel J. Heidelbaugh, MD, FAAFP, FACG, Consulting Editor
      “Thank you, thank you so much doctor for listening to me, for always being there for me. Even though I can’t get to the office, just the ability to see you on video and have you listen to me for 15 minutes has brightened my day. I don’t want to take medications; I just need someone to listen to what’s been going on. I can’t thank you enough. I have been so incredibly anxious and depressed lately. Don’t worry, I’m not going to harm myself or anyone else. I just want to get some peace of mind. What do you think about using one of those cell phone apps to help my mood? Do they even work? Can we chat again next month? In the meantime, do you think staying off of social media will help my moods? Sometimes people can be so mean.” (paraphrased, yet near verbatim)
      Examples of similar patient encounters such as this one I experienced last week are exceedingly common in our practices. To say that “the world has changed” since the beginning of the COVID-19 pandemic in March 2020 is a vast understatement. Few would argue that people are less stressed, less anxious, or less depressed. Prior to the pandemic, there was a substantial and often unmet need for mental health services across our practices. Since 2020, the demand for these services has multiplied to the point of visible and crippling shortages that have created delays in care, greater utilization of urgent and emergent care services, and often the absence of care addressing the need for mental health support. I have been a family physician for over 23 years and still practice broad-spectrum primary care except obstetrics. While I am neither a psychiatrist nor a therapist, I often function in the role of one or both every single day in some capacity.
      This issue of Primary Care: Clinics in Office Practice addresses many salient topics and concepts germane to addressing and managing the mental health needs of our patients in primary care practices. The issue commences with a stimulating article highlighting motivational interviewing skills, a concept rarely and inadequately taught in most medical education settings, and one which takes a significant length of time within one’s career to come close to mastering. A novel concept for an article follows, one that dives deep into the utility of mobile apps for treating depression. Certainly, as mental health care resources have contracted and the demand for timely services has skyrocketed, alternative methods of care including self-help options have sprung to the forefront of patient-directed opportunity. Additional articles address the spectrum of attention-deficit disorder both with and without hyperactivity, disparities across patients with substance abuse disorders, suicide, adjustment disorders, eating disorders, obsessive-compulsive disorders, postpartum depression, and depression in the geriatric population. While I learned much new material and skills from each article, I likely learned the most from the article on adverse childhood events and trauma-informed care. This is a rapidly evolving area with great research that provides relevant awareness with the potential for shaping the care we deliver in a much more patient-centered fashion.
      I would like to thank Dr Meagan Vermeulen, who did a superlative job as the guest editor of this issue in creating a practical and varied collection of articles centered on important topics in mental health issues we commonly encounter in primary care. I trust that this issue of Primary Care: Clinics in Office Practice will serve as a benchmark for both clinical practice and education across many levels. I would also like to acknowledge the many knowledgeable authors who provided detailed and well-written articles highlighting the current literature. Similar to our recent Primary Care: Clinics in Office Practice issues, it is my hope that this compendium will serve as an educational tool for students and residents across a wide variety of medical fields, as the information herein is applicable to nearly every specialty of health care. Most importantly to our patients, know that we are always here for you.