Realizzare il modello biopsicosociale nelle cure primarie. Medico e psicologo insieme? L'opinione dei medici di medicina generale.

General Practitioners (GPs) in daily practice have to face a large variety of complex suffering conditions and demands involving physical, subjective, cultural and relational components. Adopting a biopsychosocial approach should be ideally the best way to offer an efficient primary care to citizens. However, many epistemological, cultural and organizational constrains prevent from the adoption of prevention, diagnosis and intervention practices that are really based on an integrated, systemic and complex vision. Among such constraining factors there are the overspecialization of medical specialties, the explosion of instrumental diagnostics, and the increasing proceduralization of diagnostic and intervention processes. To find possible ways to remove these constrains we investigated the GPs' point of view on the implementation of the biopsychosocial model in primary care, with a particular attention on how they consider possible to integrate their competency with those of a primary care psychologist. In the first study we conducted the opinions of 52 Italian GPs were collected through 6 focus groups of 6-10 participants each. The GPS were asked to speak about the role and functions of GPs and psychologists in primary care and about their management of psychological aspect emerging in daily practice. In a second study we conducted a survey on 119 GPs asking how much they think of the primary care as requiring a biopsychosocial approach and if they consider collaboration with psychologists useful to reach this complexity. The results showed that GPs consider useful and necessary to embrace a biopsychosocial approach in the primary care setting because the psychological aspects of patients’ suffering are often prevailing or mixed with the physical ones. However, for them the management of patients’ and practitioners' emotions require a non-obvious competence, especially considering the small amount of time they can dedicate to each patient; the most part of GPs think to not have a such competence so much so that in most cases they refer the patients presenting some psychological issues related to their physical illness to a psychologist. A more integrated action of GP and psychologist within primary care setting is not still thought and felt as a doable and useful strategy to change the practice in a biopsychosocial way. From results therefore appears to be there a gap in primary care between what ideally should be done and what is actually done. GPs would want to orient their practice in a more biopsychosocial way but some practical as well as cultural, epistemological and educational reasons still constraint them. We proposed the joint intervention of GPs and psychologist as a technical and cultural device that can actually activate an integrating and reflecting thinking in patients and in primary care professionals that broaden the response given to complexity of patients’ needs.