Harlow Robinson, was referred to a “stress management” physician to help him handle the demands of chairing the history department at Northeastern University in Boston. The breathing exercises he has since learned allow him to take a few minutes during the day to “find a little serenity.”

Dr. Aditi Nerurkar of Beth Israel Deaconess Medical Center in Boston began her stress management practice last June after seeing that stress counseling was somewhat nonexistent in primary care practices. Research has shown that 60 to 80 percent of medical complaints are exacerbated or triggered by stress.

“A lot of chronic conditions that we see in primary care have a link to stress, like migraines, stomach complaints, depression and insomnia. And stress is a known factor for heart disease and diabetes,” said Dr. Neururkar

Dr. Russell Phillips, director of Harvard Medical School’s Center for Primary Care says doctors are pressed for time during routine 15-minute office visits. Doctors may find it  simpler and more practical to write prescriptions for antidepressants and painkillers than to explore life issues that may be compounding physical or psychological symptoms. “Many physicians don’t feel prepared to teach stress management techniques, and it raises the question as to whether it’s something that a doctor does or perhaps that a health coach should do,” he said.

Dr. Phillips is working on a project in 19 large primary care practices in Massachusetts teaching hospitals to develop more team-based approaches to care by supporting general practitioners who don’t have the time or skill by providing mental health counseling and other services.

Meditation classes, yoga and tai chi are being offered in Phillips’s initiative, though getting insurance to pay for the classes can be difficult, especially if a doctor isn’t the one teaching the class.

Boston Medical Center has been able to get insurance coverage for patients in it’s stress management program by putting doctors in charge of two-hour weekly classes that teach skills such as deep breathing, healthy cooking, yoga and tai chi. “We’re really interested in teaching these techniques to help patients reduce pain from chronic conditions like arthritis to reduce their reliance on prescription painkillers like narcotics,” said Dr. Paula Gardiner, an internist at Boston Medical Center.

Johnnie Fuller said the classes he took at Boston Medical Center helped him manage his tension headaches and knee arthritis without acetaminophen or ibuprofen, and helped him cope with depression. He learned to take 20 minutes of daily “me time” whenever he felt overwhelmed. “I went into a room by myself and practiced slow, deep breathing. In the beginning, I didn’t think it would help, but the more I did it, the more the tension lifted.”    The Boston Globe   11/4/13




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