2 Comments
Mar 10Liked by Arpan Parikh, MD MBA FAPA

Enjoyed this article (as I do all y'all's thoughts)!

Coming from the non-behavioral world where we routinely were collecting PHQ-9's, a challenge will be how to have coherent and integrated mechanisms to treat deviations from the patient's level. Will we always refer back to the patient's behavioral health provider? Will generalists (and possibly specialists) have time and interest to manage medication titration? Especially as payers start to mandate collection of these measures, we will need folks like y'all to guide us on how to manage these scores.

Second is that while a patient may not say that their PHQ-9 is too high (yet), patients do notice if they've gained weight or if their blood pressure is higher. I think that folks are pretty adaptable as exemplified by those who take a more quantified approach to their health who literally lose sleep over their sub optimal sleep scores from their wearables. I think that as the measures are more wide spread and patients/providers understand the benefits of the measures and interventions, we will see patients asking for about changes in their scores.

Expand full comment
author

On your first point - spot on! As we all know, adage #1 in medicine is don't ask a question / do a test if you don't know what you're going to do with the answer / result. As we begin gathering data related to behavioral health more widely, it will be critically important to empower those non-specialists on the front lines to assess, ingest, and act on 'abnormal' values appropriately (and we are very bullish on the Collaborative Care Model [CoCM] as a key tool in this toolbox - hi Bend Health!).

On the second, we see where you're coming from. It's a balance, as even though we may be more in tune with our emotional health than our physical health, it is also a fluctuating state (more so than, say, weight) with less objective data points in day-to-day life. We sincerely hope more folks demand quantitative data around their mental health and use it to gauge the effectiveness of interventions being undertaken by their care teams, just as they routinely do for other conditions like T2DM, HTN, etc.

Expand full comment