Health disparities in primary care remain a continual challenge for both practitioners and patients alike. Integrating mental health services into routine patient care has been one approach to address such issues, including access to care, stigma of health-care providers, and facilitating underserved patients’ needs. This article addresses examples of training programs that have included mental health learners and licensed providers into family medicine residency training clinics. Descriptions of these models at two Midwestern Family Medicine residency clinics in the United States (...) are highlighted. Examples of cross-training both medical residents and mental health students are described, detailing specific areas where this integration improves mental health and medical outcomes in patients. Challenges to effective integration are discussed, including larger system buy-in, medical providers’ knowledge of mental health treatment, and the skills for clinical providers to possess in order to present mental health options to patients. Patients who traditionally experience multiple barriers to mental health treatment now have increased access to comprehensive care. As a result of more primary care clinics ascribing to an integrated care model of practice, providers may benefit from not only increased coordination of patient services but also utilizing behavioral health professionals to address health barriers in patients’ lives. (shrink)

To provide effective care physicians must attend, not just to medical issues, but also to the social determinants of health — racial factors, food insecurity, housing instability, transportation barriers and beyond. Social determinants also include a largely underrecognized dimension: legal vulnerabilities such as rental evictions and debt adjudications. Yet rarely do medical trainees have an opportunity to witness legal vulnerabilities, firsthand.

Yes, Roya, a 2016 graphic novel written by C. Spike Trotman and illustrated by Emilee Denich, depicts Roya, a woman of color who writes and illustrates a comic strip; Joe, a white man who gave up his career after meeting Roya, who now publishes under his name; and Wylie, a young white man starting in the profession. Roya completely dominates Joe’s career, making it hers. She also partly dominates Wylie’s, acting as his mentor. Roya dominates Joe and Wylie personally (...) too. She is their sexual dominant, and they are her submissives. Professionally and personally, moreover, Joe and Wylie each submit to Roya consensually. Further, though Roya both writes and illustrates her comic strip, often writer and illustrator differ. The former, creating the story, dominates the latter, illustrating the story after the fact – as Trotman and Denich themselves did consensually via a contract when creating their graphic novel. Hence Yes, Roya highlights domination and submission in comics creation and in sex. More than that, the graphic novel also presents both kinds of domination and submission as ethical. Because Aristotle, Kant, and Mill are the most influential ethicists in the Western tradition, this chapter investigates how each could accommodate such professional and personal dominant/submissive relationships in their philosophy. (shrink)