STAVOVI LIJEČNIKA OBITELJSKE MEDICINE PRIMORSKO-

GORANSKE ŽUPANIJE PREMA PSIHOLOŠKIM METODAMA

U LIJEČENJU SOMATSKIH BOLESTI

/ ATTITUDES OF FAMILY MEDICINE DOCTORS IN

PRIMORJE-GORSKI KOTAR COUNTY TOWARDS
PSYCHOLOGICAL METHODS IN THE TREATMENT OF
SOMATIC DISEASES
Arbanas Jasminka, Frančišković Tanja

SAŽETAK/ABSTRACT

Stoljećima je etiološkim promišljanjima u medicini dominirao dualizam psihološkog i tjele-

snog. Četrdesetak godina star Engelov koncept biopsihosocijalnog uzroka ponudio je temelje
holističkom pristupu koji uvažava biološke, socijalne i psihološke faktore u nastanku svake
bolesti. Ipak, u praksi i edukacijskim programima medicinskih stručnjaka zapravo prevlada-
va biološki pristup. Liječnici obiteljske medicine (LOM) imaju veću mogućnost prepoznati i
uvažiti psihosocijalne dimenzije bolesti u usporedbi s liječnicima sekundarnog nivoa, koji su
i inače skloniji partikularnom, biološkom pristupu. Oni su stoga ključni čimbenici u realizaci-
ji biopsihosocijalnog pristupa koji podrazumijeva liječenje koje će, osim biološke, sadržavati
socijalnu i psihološku komponentu. To podrazumijeva i upućivanje pacijenata sa somatskim
bolestima na neki od psiholoških oblika liječenja. Da bi se ispitalo kakav stav prema psiho-
loškim metodama liječenja imaju LOM i u kojoj mjeri upućuju svoje somatske pacijente na
njih, kontaktirani su zaposlenici i koncesionari Doma zdravlja Primorsko-goranske županije.
U istraživanju su primijenjeni: Opći upitnik demografskih podataka, dva kratka upitnika
strukturiranih za potrebe ovog istraživanja te Upitnik stavova o traženju stručne psihološke
pomoći - skraćeni oblik (ATSPPH-SF). Rezultati govore da LOM imaju pozitivne osobne stavo-
ve o traženju stručne psihološke pomoći, neovisno o spolu i godinama radnog staža. Usprkos
tome tek ponekad somatske pacijente upućuju psihijatru ili na psihološke metode liječenja,
a rijetko na grupe samopomoći. Upućivanje ne ovisi o stavovima prema traženju psihološke
pomoći i pohađanju edukacija iz psiholoških metoda liječenja, ali je u pozitivnom odnosu s
godinama radnog staža. Preko 50 % upućivanja psihijatru i na psihološke tretmane odnosi
se na pacijente s nediferenciranim somatskim simptomima, slijede gastrointestinalne, ma-
ligne i kardiovaskularne bolesti. U grupe samopomoći liječnici najviše upućuju pacijente
s malignim bolestima (30,5 %), slijede gastrointestinalne, neurološke i reumatske bolesti.

/ For centuries, etiological considerations in medicine have been dominated by the dualism
of psychological and physical. Engel’s forty-year-old concept of biopsychosocial cause laid 3
 Izvorni znanstveni članak

the foundation for a holistic approach that acknowledges the biological, social and psycho-
logical factors in the origin of every disease. However, in practice and educational programs
of medical professionals, the biological approach actually prevails. Family medicine doctors
(FMDs) have a greater ability to recognize and appreciate the psychosocial dimensions of a
disease compared to secondary level doctors who are otherwise more inclined to a particular,
biological approach.
They are, therefore, key factors in the realization of a biopsychosocial approach which im-
plies treatment that will include a social and psychological component, in addition to the
biological one. This includes referring patients with somatic diseases to some form of psy-
chological treatment. We contacted employees and concessionaires of the Primorje-Gorski
Kotar County Health Centre in order to examine the attitudes towards psychological treat-
ment methods of FMDs and to what extent they refer their somatic patients to them. The
following instruments were used in the research: the General Demographic Data Question-
naire, two short questionnaires structured for the purposes of this study and the Attitudes
Toward Seeking Professional Psychological Help Scale – Short Form (ATSPPH-SF). The re-
sults show that FMDs have positive personal attitudes in reference to seeking professional
psychological help, regardless of gender and years of service. Despite this, somatic patients
are only sometimes referred to a psychiatrist or for psychological treatment, and rarely to
self-help groups. Referral does not depend on attitudes towards seeking psychological help
and attending training in psychological treatment methods, but is positively related to years
of service. Over 50% of referrals to psychiatrists and for psychological treatments refer to
patients with undifferentiated somatic symptoms, followed by gastrointestinal, malignant
and cardiovascular diseases. Doctors mostly refer patients with malignant diseases to self-
help groups (30.5%), followed by gastrointestinal, neurological and rheumatic diseases.

KLJUČNE RIJEČI / KEYWORDS

Psihološka pomoć / Psychological help, tjelesna bolest / physical illness, psihosomatska

bolest / psychosomatic illness, liječnik / doctor, stavovi / attitudes

Arbanas Jasminka, Klinika za psihijatriju, KBC Rijeka, Kontakt: lukajasminka@[Link]

Frančišković Tanja, Fakultet zdravstvenih studija, Sveučilište u Rijeci
/ Arbanas Jasminka, Psychiatry Department of Clinical Hospital Centre Rijeka, Contact: lukajasminka@[Link]
/ Frančišković Tanja, Faculty of Health Studies, University of Rijeka

TO LINK TO THIS ARTICLE: [Link]

4
Psihoterapija 2023.; vol. 37, br. 1-2: 3-36

UVOD INTRODUCTION

Za razliku od tradicionalne, zapadna je Unlike traditional medicine, Western me­

medicina stoljećima bila obilježena di- dicine has been affected by the body-soul
hotomijom tijela i duše, zanemarujući dichotomy for centuries, ignoring the
psychological factors in somatic diseas-
psihološke čimbenike kod somatskih
es. Engel’s 40-year-old concept of the bio-
oboljenja. Četrdesetak godina star En-
psychosocial cause of somatic diseases
gelov koncept biopsihoscijalnog uzroka
provided the foundations for a holistic
somatskih oboljenja ponudio je temelje
approach and was perceived as a novel-
holističkom pristupu, te je doživljen kao ty in Western medicine, becoming one of
novina u zapadnoj medicini, postavši the most cited medical papers (1). At ev-
jedan od najcitiranijih medicinskih čla- ery step in the development, treatment or
naka (1). Na svakom koraku tijekom ra- healing of a somatic disease, we must bear
zvoja, liječenja i zalječenja ili izlječenja in mind that psychological factors play
neke somatske bolesti, moramo imati an important role and that the outcome
na umu da psihološki čimbenici igraju of medical procedures will largely depend

veliku ulogu i da će o njima uvelike ovi- on them. However, the biological approach
still prevails in the everyday practice and
siti ishod lječidbenih postupaka. Ipak,
educational programs of medical profes-
u svakodnevnoj praksi i edukacijskim
sionals, whether in somatic medicine or
programima medicinskih stručnjaka
even in the approach to mental disorders,
još uvijek prevladava biološki pristup, and the attention is often focused exclu-
kako u somatskoj medicini tako čak sively on physical changes and processes
i u pristupu mentalnim poremećaji- (2). Doctors are thus caught in a dilemma
ma, prema kojima se nerijetko pažnja about which concept they should follow
usmjerava isključivo na tjelesne pro- in their work (3).
mjene i procese (2). Liječnici su zapravo
Numerous studies have confirmed the
dovedeni u dilemu, kojem se konceptu
impact of cumulative biopsychosocial
prikloniti u svojem radu (3).
factors on the onset and course of a dis-
ease (4, 5, 6). Psychological treatment
Brojne studije potvrdile su utjecaj ku-
methods that rely on various forms of
mulativnih biopsihosocijalnih čim-
communication with a specialist can
benika na pojavu i tijek bolesti (4,5,6).
ease the pain and suffering not only in
Psihološke metode liječenja raznim
people with mental disorders, but also
oblicima komunikacije sa stručnja- in patients with physical diseases (7,
kom olakšavaju bol i patnju ne samo 8). During the process of psychological
u osoba s mentalnim poremećajima treatment, it is necessary to meet the
već i kod oboljelih od tjelesno katego- following basic criteria: the availability of 5
 Izvorni znanstveni članak

riziranih bolesti (7,8). Tijekom procesa mental health professionals, reduction of

psihološkog liječenja neophodno je anxiety in a safe counselling, sociothera-
zadovoljiti osnovne kriterije: dostu- peutic or psychotherapeutic relationship,
with the possibility of emotional venting
pnost stručnjaka mentalnog zdravlja,
and emotional interpretation. The pro-
smanjenje tjeskobe u sigurnom savje-
cedure requires all the participants to be
todavnom, socioterapijskom ili psiho-
actively involved and to have trust in the
terapijskom odnosu, uz mogućnost za
validity of psychological methods (9).
ventilaciju emocija i njihovo tumače-
nje. Postupak zahtijeva aktivnost svih Psychotropic medication, counselling,
sudionika i vjerovanje u valjanost psi- various individual and group psycho-
hološke metode (9). therapy techniques, sociotherapeutic
techniques, psychoeducational inter-
Psihotropna medikacija, savjetovanja, ventions and stress management proce-
različite individualne i grupne psi- dures can significantly affect the course
hoterapijske tehnike, socioterapijske and outcome of a disease. The modern
tehnike, psihoedukacijske intervenci- psychological approach is also support-
ed through neuroscientific research that
je, postupci upravljanja stresom, mogu
provides the possibility of measuring the
značajno utjecati na tijek i ishod bolesti.
response to therapeutic interventions
Suvremeni psihološki pristup podržan
(10, 11). The integration of positive ther-
je i putem neuroznanstvenih istraživa-
apeutic experiences reduces emotional
nja koja pružaju mogućnost mjerenja suffering and stimulates the growth and
odgovora na terapijske intervencije development of personality. For exam-
(10,11). Integracija pozitivnih terapij- ple, research has shown that short psy-
skih iskustava umanjuje emocionalnu chodynamic psychotherapy carried out
patnju i potiče rast i razvoj osobnosti. through an individual program can im-
Primjerice, istraživanje je pokazalo da prove the patient’s coping with a physical
kratka psihodinamska psihoterapija illness and enable emotional adjustment,

kroz individualni program može kori- thus facilitating their recovery (12).

girati suočavanje s tjelesnom bolešću i Literature references refer mainly to

omogućiti emocionalnu prilagodbu te the use of psychological methods in the
time utjecati na brži oporavak (12). treatment of somatic diseases by pre-
senting individual cases or describing
Literaturni podatci uglavnom se od- the theory within a particular psycho-
nose na uporabu psiholoških metoda therapeutic approach (4, 5, 6, 13, 14, 15, 16,
u liječenju somatskih bolesti kroz pri- 17). Meta-analyses indicate that psycho-
kaze pojedinih slučaja ili opisane teo- therapeutic methods of longer duration
6 rije unutar pojedinog psihoterapijskog have a more intense effect on the symp-
Psihoterapija 2023.; vol. 37, br. 1-2: 3-36

pravca (4,5,6,13,14,15,16,17). Meta-anali- toms of both psychiatric and somatic

ze ukazuju da psihoterapijske metode disorders (7). Their validity is assessed
s dužim trajanjem imaju intenzivniji through their ability to alleviate pain,
učinak na dobrobit kako psihijatrijskih anxiety, depression and the intensity of
tako i somatskih poremećaja (7). Vri- somatic ailments (18). A long-term fol-
low-up of somatic patients undergoing
jednost se procjenjuje kroz ublažavanje
cognitive behavioral group therapy estab-
doživljaja patnje, anksioznosti, depre-
lished significant changes in their social
sije te intenziteta somatskih tegoba
adjustment, as well as a positive effect
(18). Dugotrajno praćenje somatskih
on their somatic and psychiatric symp-
pacijenata, liječenih kognitivno bihevi-
toms (19). It was also confirmed that psy-
oralnom terapijom u grupnom tretma-
chological interventions have beneficial
nu, utvrdilo je značajne promjene u so-
effects on the optimization of immune
cijalnoj prilagodbi, pozitivnom učinku function, including an improved healing
na somatske simptome i ublažavanje of burns, surgical wounds, fractures and
psihijatrijskih simptoma (19). Potvr- ulcer wounds (4, 20, 21). Psychological in-
đen je utjecaj psihološke intervencije terventions also had a significant effect
na optimizaciju imunološke funkcije, on the recovery of patients with an acute
čak i utjecaj na poboljšano cijeljenje coronary syndrome, by affecting their
opekotina, kirurških rana, prijeloma i anxiety, depression and acceptance of
ulkusnih rana (4,20,21). Psihološke in- illness (22).
tervencije imale su značajan učinak i
People suffering from same diseases of-
na oporavak u akutnom koronarnom
ten seek support in self-help groups or
sindromu djelujući na anksioznost,
volunteer organizations (23). There are
depresiju i prihvaćanje bolesti (22). 3,300 registered active associations in the
field of health protection in Croatia. Re-
Osobe sa zajedničkom zdravstvenom
ferral of patients to such groups is most
problematikom nerijetko podršku traže
commonly motivated by the effort to help
u grupama samopomoći ili udrugama
patients cope better with the awareness
koje su načelno volonterske (23). U Hr-
of potentially incurable or fatal illnesses.
vatskoj postoji 3 300 registriranih aktiv-
These groups are characterized by dy-
nih udruga u području zaštite zdravlja. namics rooted in support and empow-
Upućivanje pacijenata u takve grupe erment through social exchange (24). A
najčešće je motivirano nastojanjem da family medicine doctor (FMD) serves as
se bolesnici bolje nose sa spoznajom o the patient’s initial point of contact with-
potencijalno neizlječivom ili smrtnom in the healthcare system, and is also the
oboljenju. Obilježava ih dinamika te- one who receives information referring
meljena na podršci i osnaživanju kroz to all other medical procedures. They 7
 Izvorni znanstveni članak

društvenu razmjenu (24). Obiteljski li- have more frequent interactions with
ječnik prva je komunikacija pacijenta the patient, and sometimes even with the
sa zdravstvenim sustavom, a također patient’s entire family, compared to oth-
je i onaj koji dobiva informacije iz svih er participants in the healthcare chain.
ostalih medicinskih postupaka. On/a In so doing, they have a comprehensive
understanding of the patient’s health
češće ima kontakt s pacijentom, neri-
condition, and by practicing a compre-
jetko i cijelom njegovom obitelji od dru-
hensive approach, they can bridge the
gih sudionika u lancu zdravstvene skr-
physical-psychological dichotomy and
bi. Na taj je način u prilici imati cjelovitu
can also provide a somatic patient with a
sliku njegovog zdravstvenog stanja pa
psychological intervention or refer them
je svojim prakticiranjem sveobuhvat-
to one. The use of psychological meth-
nog pristupa u mogućnosti premosti-
ods in the clinical practice of a family
ti dihotomiju tjelesno – psihološko i medicine doctor is also possible through
pružiti ili uputiti somatskog pacijenta a dyadic relationship, because in every
i na psihološku intervenciju. Primjena encounter, even the smallest amount of
psiholoških metoda u kliničkom radu empathy can have therapeutic effects or
obiteljskog liječnika moguća je i kroz serve as an impetus for engaging in other
dijadni odnos jer pri svakom susretu i psychological interventions (16). Howev-
najmanja doza empatije može djelova- er, attitudes towards this approach, along
ti terapijski ili kao impuls za uključiva- with the prevailing biological paradigm,
nje u druge intervencije iz psihološkog are largely influenced by mistrust and
spektra (16). Međutim, stavovi o tome, stigma associated with mental difficul-
uz prevladavajuću biološku paradigmu, ties and psychological treatment meth-
ods (25).
uvelike su pod utjecajem nepovjerenja
i stigme vezanih za mentalne teškoće i The education of doctors mainly provides
psihološke metode liječenja (25). information that should guide them in
understanding the importance of the
Izobrazba liječnika uglavnom daje infor-
psychological component in the treat-
macije koje bi trebale koristiti liječnici-
ment of somatic diseases. Research has
ma u razumijevanju važnosti psihološke
shown that primary care physicians have
komponente u liječenju somatskih bole- a greater ability to recognize and ac-
sti. Istraživanja su pokazala da liječnici knowledge the psychosocial dimensions
primarne zaštite imaju veću mogućnost of diseases compared to secondary-lev-
prepoznati i uvažiti psihosocijalne di- el physicians who lean more towards a
menzije bolesti u usporedbi s liječnicima specific, biological approach (26, 27, 28).
sekundarnog nivoa, još sklonijim parti- Primary care physicians are, therefore,
8 kularnom, biološkom pristupu (26,27,28). the key factors in the implementation of
Psihoterapija 2023.; vol. 37, br. 1-2: 3-36

Stoga su upravo liječnici primarne zašti- a biopsychosocial approach that takes

te ključni čimbenici u realizaciji biopsi- into account all three groups of etiolog-
hosocijalnog pristupa koji uvažava sve ical factors contributing to the onset of
tri grupe etioloških čimbenika u pojavi a disease. However, certain studies have
neke bolesti. No neka istraživanja su shown that despite the theoretical accep-
tance of the biopsychosocial approach
pokazala da se, unatoč načelnom pri-
and focus on the individual and the in-
hvaćanju biopsihosocijalnog pristupa i
volvement of the patient in treatment
usmjerenosti na pojedinca te uključiva-
process, the biological model is most
nja pacijenta u liječenje, u praktičnom
often used in the practical work of doc-
radu liječnika koristi najčešće biološki
tors. The reason cited is the lack of time
model. Kao razlog se navodi nedosta-
and organization in healthcare, which
tak vremena i organizacija zdravstvene
tends to evaluate effectiveness through
skrbi koja uspješnost analizira kroz bio- biomedical markers, clinical innovations
medicinske markere, kliničke inovacije i and immediate financial gains. (3).
neposredni financijski dobitak (3).
Studies have shown that FMDs perceive
Studije pokazuju da LOM smatraju da je psychological intervention as necessary
psihološka intervencija neophodna za for the majority of patients, yet they do
većinu pacijenata no samostalno ih ne not implement them themselves and
provode, a upućivanja na tretmane su referrals for treatments are extremely
izuzetno rijetka (26). Liječnici navode rare (26). Doctors report that nearly 70%
da gotovo 70 % bolesnika u obiteljskoj of patients in family medicine require
medicini zahtijeva psihološku podršku. psychological support. If they do conduct
Ako sami i provode intervencije to je interventions themselves, it is predomi-
nantly in the form of emotional support
najčešće u vidu emocionalne podrške
and counselling, but they mostly high-
i savjetovanja, no najčešće ističu nedo-
light the lack of formal training (27, 29). It
statak formalne obuke (27,29). Značaj-
is important to note that among doctors,
no je napomenuti da među liječnicima,
even mental health professionals them-
pa i samim stručnjacima mentalnog
selves, there is resistance in accepting
zdravlja postoji otpor u prihvaćanju i
their own psychological problems. Quite
vlastitih psiholoških tegoba. Nerijetko often, even if they experience such chal-
kada ih i imaju, smatraju da moraju biti lenges, they believe they must exhibit
emocionalno otporni te da bi priznava- emotional resilience and fear that ac-
nje psihičkih problema vodilo u diskri- knowledging psychological issues would
minaciju u njihovom okruženju (30,31). lead to discrimination in their environ-
Usprkos svemu navedenom, istraživa- ment (30, 31). Despite all of the above, re-
nja pokazuju da su LOM uvelike svjesni search has shown that FMDs are largely 9
 Izvorni znanstveni članak

i osjetljivi na psihološke probleme svo- aware of and sensitive to the psychologi-

jih pacijenata (32,33). cal problems of their patients (32, 33).

Preporuka svjetske zdravstvene orga- The recommendation of the World Health

nizacije jest da se briga o mentalnom Organization is to integrate mental
zdravlju integrira u primarnu zdrav- health care into the primary health care
of all patients. The existing developed
stvenu zaštitu za sve pacijente. Posto-
practices in Europe and worldwide show
jeće razvijene prakse u Europi i svijetu
numerous advantages, such as a higher
pokazuju brojne prednosti poput veće
likelihood of positive outcomes, reduc-
vjerojatnosti pozitivnih ishoda, sma-
tion of relapses and increase in quality of
njenje recidiva i porast kvalitete života.
life. Naturally, achieving such results re-
Naravno, preduvjet za postizanje rezul- quires sufficient human, time and finan-
tata su dostatni ljudski, vremenski i fi- cial resources, as well as connection with
nancijski resursi te povezanost s višim higher levels of care and institutions (34).
razinama skrbi i institucijama (34).
The aim of this paper is to examine the
Cilj ovog rada je ispitati osobnu spre- personal willingness of FMDs to seek
mnost LOM-a na traženje psihološke psychological help, to determine how fre-
pomoći, utvrditi koliko često upućuju quently they refer their patients suffering
svoje pacijente koji boluju od somat- from somatic diseases to psychological
skih bolesti na psihološke intervencije, interventions, and to identify the most
te radi kojih oboljenja to čine najčešće. common conditions for which they do.

Nadalje, analiziran je odnos osobne Furthermore, the relationship between

the personal willingness of FMDs to seek
spremnosti LOM na traženje psiho-
psychological help and the frequency of
loške pomoći i učestalost upućivanja
referring patients with somatic diseases
pacijenata sa somatskim bolestima na
to psychological interventions is also an-
psihološke intervencije.
alyzed.

ISPITANICI I METODE
RESPONDENTS AND METHODS
Ispitanici u ovom istraživanju bili su
The respondents in this study were fami-
liječnici obiteljske medicine, zaposle- ly medicine doctors, employees and con-
nici i koncesionari Doma zdravlja Pri- cessionaires of the Primorje-Gorski Kotar
morsko-goranske županije sa popisa County Health Centre from the list and
i kontakata na web stranicama Doma contacts on the Health Centre’s website.
zdravlja PGŽ. Njih 84 radi u timovima Among them, 84 work in the Health Cen-
10 Doma zdravlja, a 91 liječnik je konce- tre teams and 91 doctors are concession-
Psihoterapija 2023.; vol. 37, br. 1-2: 3-36

sionar. To čini uzorak od ukupno 165 aires, resulting in a total sample of 165
liječnika obiteljske medicine. family medicine doctors.

Presječno eksperimentalno istraživa- The cross-sectional experimental study

nje provedeno je u razdoblju od 01.05. was conducted in the period from 1 May to
30 June 2022, via an online survey ques-
do 30.06.2022. godine putem internet-
tionnaire using the Google Forms plat-
skog anketnog upitnika platformom
form, after obtaining the approval of the
Google Forms, nakon dobivene dozvo-
Ethics Committee of the Primorje-Gorski
le Etičkog povjerenstva Doma zdravlja Kotar County Health Centre and the Eth-
Primorsko-goranske županije i Etičkog ics Committee of the Rijeka Faculty of
povjerenstva Fakulteta zdravstvenih Health Studies. The participants required
studija Rijeka. Vrijeme potrebno za po- approximately 8 minutes on average to
punjavanje svih stavki ankete bilo je complete all the items of the survey.
prosječno 8 minuta.

Procedure and Instruments

Postupak i instrumenti
A questionnaire containing basic infor-
Upitnik s osnovnim podatcima, infor- mation, informed consent and survey
scales was sent via email to 165 address-
miranim pristankom i anketnim ska-
es of family medicine doctors, employees
lama dostavljen je putem elektroničke
and concessionaires of the PGC Health
pošte na 165 adresa liječnika obiteljske
Centre. Doctors who did not fill out the
medicine, zaposlenika i koncesionara questionnaire within 15 days were sent a
Doma zdravlja PGŽ. Liječnicima koji reminder after two weeks, and the process
nisu ispunili upitnik kroz 15 dana po- was repeated after another two weeks.
slan je podsjetnik nakon dva tjedna, a
In order to obtain basic demographic data
postupak je ponovljen također nakon
for the purposes for this study, a General
dva tjedna.
Questionnaire was structured consisting
U svrhu dobivanja osnovnih demograf- of seven questions about gender, years
of professional experience, education
skih podataka za potrebe ovog istraži-
in psychological techniques and differ-
vanja strukturiran je Opći upitnik koji
ences in referring somatic patients for
se sastoji od sedam pitanja o spolu, go-
psychological treatment. The dependent
dinama staža, edukaciji o psihološkoj
variable of the frequency of referrals for
tehnici te diferentnostima upućivanja treated patients suffering from somat-
somatskih pacijenata na psihološke ic diseases for psychological treatment
metode liječenja. Zavisna varijabla uče- was determined based on responses to
stalosti upućivanja zbrinjavanih paci- the following three Likert-type questions 11
 Izvorni znanstveni članak

jenata koji boluju od somatske bolesti ranging from 0 to 4: How often do you
na psihološke tretmane utvrđena je refer somatic patients; to a psychiatrist/
odgovorima na tri postavljena pitanja for psychological treatment/ to self-help
likertovog tipa od 0 do 4: Koliko često groups. These responses were operation-
upućujete somatske pacijente; psihija- alized across four options: always, often,
sometimes, rarely, never. Data for the
tru/ na psihološki tretman/ u grupe sa-
nominal variable of the type of disease
mopomoći. Operacionalizirani su kroz
for which the FMDs most frequently refer
četiri opcije: stalno, često, ponekad,
patients to psychological interventions
rijetko, nikad. Podatci za nominalnu
were obtained through three questions
varijablu vrste bolesti radi kojih LOM
requiring three diseases indicated. The
najčešće upućuje na psihološke inter-
questions are the following: For which
vencije dobiveni su pomoću tri pitanja
somatic diseases have you referred a pa-
koja zahtijevaju tri navoda bolesti. Pi- tient to a psychiatrist / for psychological
tanja su: Radi koje ste somatske bolesti treatment / to self-help groups.
pacijenta uputili psihijatru /na psiho-
loški tretman/ u grupe samopomoći? In order to assess the attitudes towards
seeking professional psychological help,
Za ispitivanje stavova o traženju struč- the Attitudes Toward Seeking Profession-
ne psihološke pomoći korištena je ska- al Psychological Help Scale – Short Form
la Attitudes Toward Seeking Professi- (ATSPPH-SF) was used, which is a stan-
onal Psychological Help-Short Form dardized psychometric scale measuring
(ATSPPH-SF), standardizirana psihome- attitudes towards seeking professional
trijska skala stavova o traženju stručne psychological help. It is available for free
psihološke pomoći. Dostupna je slobod- download from a website, with proper at-
tribution, and consists of ten questions
nim preuzimanjem s internetske strani-
(35). The scale has been used extensively
ce uz navođenje, i sastoji se od deset pi-
in the Croatian language, it was translat-
tanja (35). Skala je višekratno korištena
ed again for the purposes of this study,
na hrvatskom jeziku, također je ponovo
and then compared with the existing
prevedena za potrebe ovog istraživanje
translation (36, 37). It was used to mea-
i uspoređena sa postojećim prijevodom
sure the independent variable of doctors’
(36,37). Upotrijebljena je za mjerenje ne- subjective attitudes towards seeking psy-
zavisne varijable subjektivnih stavova chological help, operationalized through
liječnika o traženju psihološke pomoći, three factors: openness to seeking profes-
a operacionalizira se kroz tri faktora: sional help, value in seeking profession-
otvorenost traženja stručne pomoći, al help and preference to cope on one’s
vrijednost traženja stručne pomoći i own. The measuring scale consists of ten
12 osobne konfrontacije. Mjerna ljestvica Likert scale items ranging from 0 = “Dis-
Psihoterapija 2023.; vol. 37, br. 1-2: 3-36

sastoji se od 10 stavki likertove skale u agree” to 3 = “Agree”. The maximum score

rasponu 0= „Ne slažem se“ do 3 = „Sla- is 30, with a more positive outcome indi-
žem se“ Maksimalan broj bodova je 30, cating less resistance. The scale shows
a pozitivniji rezultat ukazuje na manje internal reliability ranging from 0.82 to
0.84 (35).
otpora. Skala pokazuje unutarnju pouz-
danost u rasponu od 0,82 do 0,84 (35).
Statistical data processing
Statistička obrada podataka The relationship between the personal
willingness of FMDs to use psychological
Odnos osobne spremnost LOM na ko-
treatment methods and the frequency of
rištenje psihološke metode liječenja
referring patients with somatic diseases
i učestalost upućivanja pacijenta sa
to psychological interventions was ana-
somatskim bolestima na psihološke lyzed using the Pearson correlation co-
intervencije analizirana je Pearsono- efficient. The responses referring to the
vim koeficijentom korelacije. Za nomi- nominal variable of the types of diseases
nalnu varijablu vrsta bolesti radi kojih for which FMDs most frequently refer
LOM najčešće upućuju na psihološke patients to psychological interventions
intervencije odgovori su prikazani are presented within the framework of
unutar deskriptivne statističke analize descriptive statistical analysis, in per-
i postocima, te s najučestalijim odgo- centages, and with the most frequent

vorom. Kod deskriptivne statistike za response. With regard to descriptive sta-

tistics, the arithmetic mean and standard
svaku varijablu utvrđeni su aritme-
deviation or median and corresponding
tička sredina i standardna devijacija
measures of dispersion were determined
ili medijan i pripadajuće mjere raspr-
for each variable, depending on the dis-
šenja, ovisno o raspodjeli dobivenih
tribution of the obtained results, and ap-
rezultata, te su primijenjeni odgovara- propriate parametric or non-parametric
jući parametrijski ili neparametrijski tests were applied. The statistical soft-
testovi. Za obradu podataka dobivenih ware IBM SPSS Statistics 21 was used
istraživanjem korišten je statistički to process the data obtained from the
program IBM SPSS Statistics 21. research.

REZULTATI RESULTS
U istraživanju je ukupno sudjelovao A total of 71 general practitioners partici-
71 liječnik opće medicine, od čega 17 pated in the study, 17 of which were men
muškaraca (23,9 %) i 54 žene (76,1 %), s (23.9%) and 54 were women (76.1%), with 13
 Izvorni znanstveni članak

rasponom duljine radnog staža od 0 do their work experience ranging from 0 to

42 godine. 42 years.

Edukacije iz psiholoških metoda liječe- Regarding education in psychological

treatment methods, 17 respondents (23.9%)
nja pohađalo je 17 (23,9 %) ispitanika,
underwent such training, nine of them
njih 9 (5,2 %) završilo je neku od psiho-
(5.2%) completed some form of psycho-
terapijskih edukacija (3 su završili ko-
therapy training (three in cognitive-be-
gnitivno-bihevioralnu psihoterapiju, 3 havioral psychotherapy, three in group
grupnu analizu, 2 transakcijsku anali- analyses, two in transactional analyses,
zu, jedan gestalt psihoterapiju). Ostalih one in Gestalt psychotherapy). The re-
8 liječnika (4,8 %) prošlo je edukacije za maining eight doctors (4.8%) underwent
pojedina psihološka područja, poput training in certain psychological areas,
edukacije za klub liječenih alkoholiča- such as training for alcoholism treatment,
depressive disorders treatment and vari-
ra, liječenje depresivnih poremećaja i
ous forms of psychological counselling.
razne vrste psihološkog savjetovanja.
According to the results obtained from
Prema rezultatima na ATSPPH-SF skali,
the ATSPPH-SF scale, the respondents ex-
ispitanici su iskazali pozitivan stav pre- hibited a positive attitude towards seek-
ma traženju psihološke pomoći (X=22,99; ing psychological help (X=22.99; SD=4.03).
SD=4,03). Rezultati cijelog uzorka su pri- The results of the entire sample are pre-
kazani u tablici 1. sented in Table 1.

Tablica 1. Prikaz dobivenih rezultata čestica ATSPPH-SF skale cijelog uzorka s

aritmetičkim sredinama i standardnim devijacijama
Table 1. Presentation of the obtained results of ATSPPH-SF scale items for the entire
sample with arithmetic means and standard deviations

0 1 2 3
N (%) N (%) N (%) N (%) X SD

Kad bih vjerovao da imam psihički slom, moja bi prva sklonost bila dobiti stručnu pažnju
/ If I believed I was having a mental breakdown, my first inclination would be to get professional
attention

ATSPPH_1 0 (0.0) 1 (1.4) 22 (31.0) 48 (67.6) 2.66 0.51

Ideja razgovaranja o problemima sa psihologom čini mi se lošim načinom uklanjanja

emocionalnih sukoba
/ The idea of talking about problems with a psychologist strikes me as a poor way to get rid of
emotional conflicts.

ATSPPH_2 52 (73.2) 7 (9.9) 5 (7.0) 7 (9.9) 0.54 1.00

14
Psihoterapija 2023.; vol. 37, br. 1-2: 3-36

Tablica 1. Prikaz dobivenih rezultata čestica ATSPPH-SF skale cijelog uzorka s

aritmetičkim sredinama i standardnim devijacijama (nastavak)
Table 1. Presentation of the obtained results of ATSPPH-SF scale items for the entire
sample with arithmetic means and standard deviations (continued)

0 1 2 3
N (%) N (%) N (%) N (%) M SD

Da u ovoj fazi svog života doživljavam ozbiljnu emocionalnu krizu, bio bih uvjeren da bih olakšanje
mogao pronaći u psihoterapiji
/ If I were experiencing a serious emotional crisis at this point in my life, I would be confident that I
could find relief in psychotherapy.

ATSPPH_3 2(2.8) 4 (5.6) 25 (35.2) 40 (56.3) 2.45 0.73

Postoji nešto vrijedno divljenja u stavu osobe koja je spremna nositi se sa svojim sukobima i
strahovima bez pribjegavanja stručnoj pomoći
/ There is something admirable in the attitude of a person who is willing to cope with his or her
conflicts and fears without resorting to professional help.

ATSPPH_4 23 (32.4) 17 (23.9) 25 (35.2) 6(8.5) 1.20 0.99

Da sam duže vrijeme zabrinut ili uznemiren, želio bih dobiti psihološku pomoć
/ I would want to get psychological help if I were worried or upset for a long period of time

ATSPPH_5 1(1.4) 2 (2.8) 22 (31.0) 46 (64.8) 2.59 0.62

Možda bih u budućnosti želio ići na psihološko savjetovanje

/ I might want to have psychological counselling in the future.

ATSPPH_6 9(12.7) 8(11.3) 27 (38.0) 27 (38.0) 2.01 1.01

Osoba s emocionalnim problemom vjerojatno ga neće riješiti sama; on ili ona vjerojatno će ga riješiti
uz stručnu pomoć
/ A person with an emotional problem is not likely to solve it alone; he or she is likely to solve it with
professional help.

ATSPPH_7 2 (2.8) 7 (9.9) 43 (60.6) 19 (26.8) 2.11 0.69

Uzimajući u obzir potrebno vrijeme i trošak psihoterapije, bila bi od upitne koristi osobi poput mene
/ Considering the time and expense involved in psychotherapy, it would have doubtful value for a
person like me.

ATSPPH_8 33 (46.5) 18 (25.4) 16 (22.5) 4(5.6) 0.87 0.96

Osoba treba riješiti vlastite probleme; traženje psihološkog savjetovanja bilo bi posljednja mogućnost
/ A person should work out his or her own problems; getting psychological counselling would be a
last resort.

ATSPPH_9 46 (64.6) 16 (22.5) 8 (11.3) 1(1.4) 0.49 0.75

Osobne i emocionalne tegobe, kao i mnoge stvari, obično se rješavaju same od sebe
/ Personal and emotional troubles, like many things, tend to work out by themselves.

ATSPPH_10 36 (50.7) 17 (23.9) 18 (25.4) 0 (0.0) 0.75 0.84

15
 Izvorni znanstveni članak

Rezultati su pokazali da je većina ispi- The results showed that the majority of
tanika tijekom svog radnog vijeka ba- respondents referred their somatic pa-
rem jednom uputila svojeg somatskog tient to a psychiatrist at least once during
pacijenta psihijatru, dvije trećine njih their career, two-thirds of them referred
uputili su svoje pacijente na psihološke their patients for psychological treat-
ments, and only one-third made referrals
tretmane, a tek trećina u grupe samo-
to self-help groups (Table 2).
pomoći (tablica 2).
The frequency of referring somatic pa-
Učestalost slanja somatskih pacijena-
tients to a psychiatrist, for psychologi-
ta psihijatru, na psihološke tretmane
cal treatments or to self-help groups is
ili grupe samopomoći prikazani su u
shown in Table 3.
tablici 3.
FMDs sometimes refer their somatic pa-
LOM upućuje svoje somatske pacijen- tients to psychiatrists (SD 2.77), they also
te psihijatru ponekad (X 2,77), ponekad sometimes refer them for psychological
upućuju i na psihološke metode liječe- treatment (SD 2.56), while they rarely re-
nja (X 2,56) dok u grupe samopomoći fer them to self-help groups (SD 1.93).
upućuju rijetko (X 1,93).
In the course of additional data process-
U dodatnoj obradi podataka analizirane ing, we analyzed the connections of gen-
su povezanosti između spola, duljine der, years of professional experience and

Tablica 2. Upućivanje na psihološke metode liječenja ikada tijekom radnog staža

Table 2. Referrals for psychological treatment at any point during their career

Upućivanje psihijatru ikada / Referral to a psychiatrist at any point n (%)

Da / Yes 65 (91,5 %)

Ne / No 6 (8,5 %)

Upućivanje na psihološki tretman ikada n (%)

/ Referral for psychological treatment at any point

Da / Yes 48 (67,6 %)

Ne / No 23 (32,4 %)

Upućivanje u grupe samopomoći ikada n (%)

/ Referrals to self-help groups at any point

Da / Yes 23 (32,4 %)

Ne / No 48 (67,6 %)
16
Psihoterapija 2023.; vol. 37, br. 1-2: 3-36

Tablica 3. Prikaz frekvencije odgovora, aritmetičkih sredina i standardnih devijacija

učestalosti upućivanja psihijatru, na psihološke tretmane i u grupe samopomoći
Table 3. Presentation of the response frequency, arithmetic means and standard
deviations of the frequency of referrals to a psychiatrist, for psychological treatments and
to self-help groups

Nikada Rijetko Ponekad Čest Stalno

/ Never / Rarely / Sometimes / Often / Always X SD
0 1 2 3 4
N (%) N (%) N (%) N (%) N (%)

Koliko često 5 18 38 (53,5) 8 2 2,77 0,85

upućujete somatske (7,0) (25,4) (11,3) (2,8)
pacijente psihijatru?
/ How often do
you refer somatic
patients; to a
psychiatrist?

Koliko često 10 (14,1) 21 31 8 1 2,56 0,92

upućujete somatske (29,6) (43,6) (11,3) (1,4)
pacijente na neki
od psiholoških
tretmana?
/ How often do
you refer somatic
patients for
psychological
treatment?

Koliko često 31 (43,7) 17 (23,9) 21 (29,6) 1 1 1,93 0,96

upućujete somatske (1,4) (1,4)
pacijente u grupe
samopomoći?
/ How often do
you refer somatic
patients to self-help
groups?

radnog staža i pohađanja edukacije sa completed education with attitudes to-

stavovima o traženju stručne psiho- wards seeking professional psychological
loške pomoći, upućivanja psihijatru i help, referrals to psychiatrists and psy-
na psihološke tretmane ikada i učesta- chological treatments at any point, and
losti upućivanja pacijenata na psiho- the frequency of referrals of patients to
loške metode liječenja. Prije provedbe psychological treatment. Before conduct- 17
 Izvorni znanstveni članak

ANOVA-e, odnosno analize varijance za ing ANOVA, i.e. the analysis of variance for
duljinu radnog staža, ispitanici su podi- years of professional experience, the re-
jeljeni u tri grupe s obzirom na duljinu spondents were divided into three groups
radnog staža: do 15 godina staža (n=25), based on their professional experience: up
od 16 do 30 godina staža (n=22) i više od to 15 years (n=25), 16 to 30 years (n=22), and
30 godina staža (n=24) (tablica 4.). more than 30 years (n=24) (Table 4).

Tablica 4. Aritmetičke sredine i standardne devijacije stavova liječnika opće medicine o

traženju stručne psihološke pomoći s obzirom na spol, duljinu radnog staža i pohađanje
edukacija
Table 4. Arithmetic means and standard deviations of general practitioners’ attitudes
towards seeking professional psychological help with regard to gender, length of
professional experience and participation in training

Varijable / Variables Stavovi o traženju stručne psihološke

pomoći / Attitudes towards seeking
professional psychological help

n X SD p

Spol / Gender

Muškarci / Men 17 22,53 3,86 t=-0,53, df=69, p>0,05

Žene / Women 54 23,13 4,11

Duljina radnog staža

/ Length of professional
experience

Do 15 godina staža 25 23,92 3,05 df=2, F=1,24, p>0,05

/ Up to 15 years of
experience

16 – 30 godina staža 22 22,86 4,57

/ 16 – 30 years of experience

Više od 30 godina staža 24 22,13 4,36

/ More than 30 years of
experience

Pohađanje edukacija
/ Participation in training

Da / Yes 17 23,53 4,37 t=0,63, df=69, p>0,05

Ne / No 54 22,81 3,95
18
Psihoterapija 2023.; vol. 37, br. 1-2: 3-36

Provedbom t-testa dobiveni su rezul- After conducting a t-test, the results

tati koji su pokazali da ne postoji sta- indicated that there is no statistically
tistički značajna razlika u stavovima significant difference in the attitudes of

liječnika opće medicine o traženju general practitioners towards seeking

professional psychological help with
stručne psihološke pomoći s obzirom
regard to gender (t=-0.53, df=69, p>0.05),
na spol (t=-0,53, df=69, p>0,05), s obzi-
with regard to the years of profession-
rom na duljinu radnog staža u struci
al experience (df=2, F=1.24, p>0.05) and
(df=2, F=1,24, p>0,05) te s obzirom na with regard to attending training in psy-
pohađanje edukacija iz psiholoških chological methods of treatment (t=0.63,
metoda liječenja (t=0,63, df=69, p>0,05). df=69, p>0.05).

Provedena je analiza upućivanja psihi- An analysis was conducted to explore re-

jatru, na psihološke tretmane i u gru- ferrals to psychiatrists, for psychological
pe samopomoći s obzirom na stavove treatments and to self-help groups tak-
LOM o traženju stručne psihološke ing into consideration to the attitudes of
pomoći. Rezultati su prikazani na ta- FMDs towards seeking professional psy-
chological help. The results are presented
blici 5.
in Table 5.
Rezultati t-testa su pokazali da ne po-
The results of the t-test showed that
stoji statistički značajna razlika u upu-
there is no statistically significant differ-
ćivanju pacijenata psihijatru s obzirom ence in referring patients to psychiatrists
na stavove liječnika opće medicine o with regard to the attitudes of general
traženju stručne psihološke pomoći practitioners towards seeking profes-
(t=0,73, df=69, p>0,05, r=0,012, p>0,05). sional psychological help (t=0.73, df=69,
p>0.05, r=0.012, p>0.05).
S obzirom na raspodjelu podataka, za
daljnju analizu korišten je Test sume Considering the data distribution, the
rangova, odnosno Mann-Whitney U Mann-Whitney U test, also known as
test. Rezultati su pokazali da ne postoji the Rank Sum test, was used for further
analysis. The results showed that there
statistički značajna razlika u upućiva-
is no statistically significant difference in
nju pacijenata sa somatskim bolesti-
referring patients with somatic diseases
ma na neki od psiholoških tretmana
for any of the psychological treatments
obzirom na stavove liječnika opće me-
considering the attitudes of general prac-
dicine o traženju stručne psihološke titioners towards seeking professional
pomoći (z=-1,84, p>0,05). psychological help (z=-1.84, p>0.05).

Provedba t-testa pokazala je da ne po- The implementation of the t-test showed

stoji statistički značajna razlika u upu- that there is no statistically significant 19
 Izvorni znanstveni članak

Tablica 5. Upućivanje somatskih pacijenata psihijatru, na psihološke tretmane i u grupe

samopomoći obzirom na stavove liječnika o traženju stručne psihološke
Table 5. Referral of somatic patients to a psychiatrist, for psychological treatments, and to
self-help groups based on doctors’ attitudes towards seeking professional psychological
help

Varijable / Variables Stavovi o traženju stručne psihološke

pomoći / Attitudes towards seeking
professional psychological help

n X SD r/p

Upućivanje psihijatru ikada

/ Referral to a psychiatrist at
any point

Da / Yes 65 23,09 3,96 r=0,012, p>0,05

Ne / No 6 21,83 5,04

Upućivanje na psihološki n M IQR

tretman / Referral for
psychological treatment at
any point ikada

Da / Yes 48 25 6,75 r=-0,025, p>0,05

Ne / No 23 22 4,00

Upućivanje u grupe X SD
samopomoći ikada /
Referral to self-help groups
at any point

Da / Yes 23 23,57 4,17 r=0,003, p>0,05

Ne / No 48 22,71 3,98

ćivanje pacijenata sa somatskim bole- difference in referring patients with so-

stima u grupe samopomoći u odnosu matic diseases to self-help groups in
na stavove liječnika opće medicine o relation to the attitudes of general prac-
titioners towards seeking professional
traženju stručne psihološke pomoći
psychological help (t=0.84, df=69, p>0.05,
(t=0,84, df=69, p>0,05, r=0,003, p>0,05).
r=0.003, p>0.05).
Nadalje, ispitan je odnos spola, duljine
Furthermore, the relationship between
staža i pohađanje edukacije iz psiho- gender, years of professional experience,
loških metoda i učestalosti upućivanja education in psychological methods and
20 somatskih pacijenata psihijatru, na the frequency of referring somatic pa-
Psihoterapija 2023.; vol. 37, br. 1-2: 3-36

psihološke metode liječenja ili u grupe tients to psychiatrists, for psychological

samopomoći. treatment or to self-help groups was ex-
amined.
Statistički značajna pozitivna korela-
cija dobivena je između duljine radnog A statistically significant positive cor-
relation was found between years of pro-
staža i učestalosti upućivanja pacije-
fessional experience and the frequency
nata psihijatru (r=0,268, p<0,05), učesta-
of referring patients to psychiatrists
losti upućivanja pacijenata sa somat-
(r=0.268, p<0.05), the frequency of refer-
skom bolesti na neki od psiholoških
ring patients with somatic diseases for
tretmana (r=0,385, p<0,01) učestalosti psychological treatments (r=0.385, p<0.01),
upućivanja pacijenata u grupe samo- the frequency of referring patients to
pomoći (r=0,372, p<0,01). Liječnici opće self-help groups (r=0.372, p<0.01). Gener-
medicine koji imaju dulji radni staž al practitioners with longer professional
češće upućuju pacijente sa somatskom experience refer patients with somatic
bolesti psihijatru, na neki od psihološ- diseases to psychiatrists, for psycholog-
kih tretmana te u grupe samopomoći. ical treatments and to self-help groups
more frequently. Doctors with completed
Liječnici sa edukacijom iz nekih od
education in some of the psychological
psiholoških metoda značajno su češće
methods referred their somatic patients
upućivali svoje somatske pacijente na
to self-help groups significantly more of-
grupe samopomoći. Rezultati su prika-
ten. The results are shown in Table 6.
zani na tablici 6.
The respondents listed a total of 110 somat-
Ispitanici su naveli ukupno 110 so- ic diseases for which they refer patients to
matskih bolesti zbog kojih pacijente psychiatrists. The diseases are categorized
upućuju psihijatru. Bolesti su grupi- into 10 groups based on clinical guidelines.
rane prema kliničkim smjernicama u Doctors mostly refer somatic patients with
10 skupina. Liječnici u najvećem bro- unspecified somatic symptoms (54.6%),
ju upućuju psihijatru somatske bole- gastrointestinal diseases (11.8%) and ma-

snike koji boluju od nespecificiranih lignant diseases (10%) to psychiatrists.

Patients with neurological, skin, lung,
somatskih simptoma (54,6 %), gastro-
rheumatological diseases, thyroid diseas-
intestinalnih bolesti (11,8 %) i malignih
es and obesity are less frequently referred
bolesti (10 %). Rjeđe psihijatru upućuju
to a psychiatrist. Furthermore, they listed
pacijente s neurološkim, kožnim, pluć-
87 somatic diseases for which they refer
nim, reumatološkim bolestima, bolesti patients for psychological treatments. The
štitnjače i s pretilošću. Nadalje, naveli most common referrals for psychological
su 87 somatskih bolesti zbog kojih pa- treatments included patients with un-
cijente upućuju na psihološke tretma- specified somatic symptoms (51.7%), gas- 21
 Izvorni znanstveni članak

Tablica 6. Prikaz povezanosti učestalosti upućivanja pacijenata sa somatskom bolesti

psihijatru, na neki od psiholoških tretmana i u grupe samopomoći sa stavovima o traženju
stručne psihološke pomoći duljini radnog staža, spolu i edukaciji iz psihoterapije
Table 6. Presentation of the correlation of the frequency of referring patients with
somatic diseases to a psychiatrist, for psychological treatments and to self-help groups
with attitudes towards seeking professional psychological help, length of professional
experience, gender and education in psychotherapy

Učestalost upućivanja pacijenata / Frequency of patient referrals

psihijatru na psihološki tretman u grupe samopomoći

/ to a psychiatrist / for psychological / to self-help groups
treatment

T test

Stavovi o traženju r 0,012 r -0,025 r 0,003

psihološke p 0,924 p 0,838 p 0,977
pomoći / Attitudes
towards seeking
psychological help

Duljina radnog r 0,268 r 0,385 r 0,372

staža / Length p 0,024 p 0,001 p 0,001
of professional
experience

Mann-Whitney U test

Spol / Gender X X X
2,82/2,76 2,47/2,59 2,00/1,91
SD SD SD
0,88 /0,85 0,62/1,00 0,71/1,03
p 0,87 p 0,44 p 0,49

Psihoterapijska X X X
edukacija 2,94/2,72 2,82/2,48 2,41/1,78
/ Psychotherapy SD SD SD
education 0,97/0,81 0,95/0,91 1,12/1,50
p 0,41 p 0,26 p 0,03

ne. Liječnici u najvećem broju upućuju somatskih simptoma (51,7 %), gastroin-
na psihološke tretmane somatske bo- testinalnih bolesti (11 %) i malignih bo-
22 lesnike koji boluju od nespecificiranih lesti (11 %). LOM su naveli 87 somatskih
Psihoterapija 2023.; vol. 37, br. 1-2: 3-36

bolesti zbog kojih pacijente upućuju trointestinal diseases (11%), and malignant
grupe samopomoći. Liječnici u najve- diseases (11%). FMDs also listed 87 somatic
ćem broju upućuju u grupe samopo- diseases for which they refer patients to
moći somatske bolesnike koji boluju self-help groups. The highest number of

malignih bolesti (30,5 %), gastrointe- referrals to self-help groups included pa-
tients with malignant diseases (30.5%),
stinalnih bolesti (19,4 %) i neuroloških
gastrointestinal diseases (19.4%) and neu-
bolesti (13,8 %). Rjeđe upućuju pacijente
rological diseases (13.8%). Referrals were
sa kožnim, kardiovaskularnim i pluć-
less frequent for patients with skin, cardio-
nim bolestima, bolesti štitnjače i šećer-
vascular and pulmonary diseases, as well
nom bolesti (tablica 7).
as thyroid diseases and diabetes (Table 7).

RASPRAVA DISCUSSION

Rezultati pokazuju da ispitana grupa The obtained results show that the sur-
LOM u većini slučajeva ima pozitivan veyed group of FMDs generally holds a

Tablica 7. Upućivanje psihijatru prema vrsti bolesti

Table 7. Referral to psychiatrists according to the type of disease

Upućivanje / Referral Oboljenja / Diseases Postotak

/ Percentage

Psihijatru Nespecificirani somatski simptomi 54,6 %

/ to a psychiatrist / Unspecified somatic symptoms

Gastrointestinalne bolesti 11,8 %

/ Gastrointestinal diseases

Maligne bolesti / Malignant diseases 10 %

Na psihološke tretmane Nespecificirani somatski simptomi 57,1 %

/ for psychological / Unspecified somatic symptoms
treatment Gastrointestinalne bolesti 12,7 %
/ Gastrointestinal diseases

Maligne bolesti / Malignant diseases 12,7 %

U grupe samopomoći Maligne bolesti / Malignant diseases 30,5 %

/ to self-help groups Gastrointestinalne bolesti 19,4 %
/ Gastrointestinal diseases

Neurološke bolesti / Neurological diseases 13,8 % 23

 Izvorni znanstveni članak

stav prema mogućem traženju psiho- positive attitude towards seeking psy-
loške pomoći za same sebe i psiho- chological help for themselves and to-
loškim intervencijama kod svojih so- wards psychological interventions for

matskih pacijenata i to bez obzira na their somatic patients, regardless of gen-

der, years of experience and additional
spol, staž i dodatnu edukaciju iz neke
education in psychotherapeutic ap-
od psihoterapijskih zahvata i tehnika.
proaches and techniques. FMDs are also
Također, LOM su zainteresirani za do-
interested in additional education in this
datnu edukaciju iz tog područja, nju je, field, since nearly a quarter of them have
naime, polazila gotovo četvrtina ispi- already undergone such training.
tanika.
They referred their somatic patients to
Oni su barem jednom uputili svoje so- a psychiatrist at least once, but despite
matske pacijente psihijatru, no usprkos this, in their daily practice they only oc-
tome u svojoj svakodnevnoj praksi tek casionally refer their somatic patients
ponekad upućuju svoje somatske paci- for some of the psychological treatment

jente na neke od psiholoških metoda li- methods, and even less frequently to
self-help groups. Interestingly, the re-
ječenja, a još rjeđe u grupe samopomo-
sults show that FMDs with longer pro-
ći. Zanimljiv je rezultat da LOM s većim
fessional experience refer their somatic
stažem češće upućuju svoje somatske
patients to psychiatrists more frequently,
pacijente psihijatru, a oni sa nekom od
while those with some form of related ed-
edukacija u grupe samopomoći, prem- ucation are more likely to refer patients
da je u apsolutnim vrijednostima to tek to self-help groups, albeit still relatively
ponekad. infrequently in absolute terms.

Najčešći razlog slanja somatskih pa- The most common reason for referring
cijenata na psihološke intervencije su somatic patients to psychological inter-
nediferencirani somatski simptomi. ventions is the presence of undifferenti-
ated somatic symptoms.
Dobiveni rezultati stavova o osobnom
The results obtained in relation to atti-
traženju stručne psihološke pomoći
tudes towards seeking professional psy-
među stručnjacima podudaraju se s
chological help among healthcare profes-
istraživanjima stavova liječnika (26,38).
sionals are consistent with the studies
Neke studije ukazuju da su stavovi i
on the attitudes of doctors (26, 38). Some
osobne norme prediktori budućeg po- studies indicate that attitudes and per-
našanja, te da pozitivitet dobivenih sonal norms are predictors of future be-
rezultata ima implikacije na osobni i havior, and that the positive findings have
24 profesionalni aktivitet u području men- implications for personal and profession-
Psihoterapija 2023.; vol. 37, br. 1-2: 3-36

talnog zdravlja. Ipak, druga istraživanja al activities in the area of mental health.
pokazala su da svjesnost LOM o zna- However, other studies have shown that
čaju psihološke komponente ne mora awareness among FMDs about the im-
rezultirati djelovanjem i da to ovisi, portance of the psychological compo-
osim o stavovima i o senzitivnosti, ka- nent does not necessarily translate into
action and that it depends, apart from
pacitetima osobnosti i stigmi koja prati
attitudes and sensitivity, on personali-
mentalne poremećaje (26). Naš uzorak
ty traits and the stigma associated with
odgovara ovim potonjim istraživanji-
mental disorders (26). Our sample seems
ma. Oblikovanju stavova vjerojatno
to align with these latter findings. Atti-
pridonosi kultura unutar edukacijskih
tudes are probably formed by the culture
i zdravstvenih ustanova gdje se emoci-
within educational and healthcare insti-
onalni problemi nerijetko tumače kroz
tutions, where emotional problems are
slabost karaktera. Istraživanja prove- often interpreted as a sign of weakness
dena u Filipinima, Kanadi, Australiji i of character. Research conducted in the
Hrvatskoj govore da duljina radnog sta- Philippines, Canada, Australia and Croa-
ža utječe na stavove prema traženju i tia has shown that length of profession-
upućivanju na psihološke intervencije al experience affects attitudes towards
(39,40,41,42). Prema tim istraživanjima seeking and referring to psychological
starije je liječnike iskustvo rada opre- interventions (39, 40, 41, 42). According
milo za razumijevanje kompleksnosti to these studies, older doctors’ profes-
ljudskog zdravlja pa i svojeg osobnog, sional experience helped them under-
te povećalo fleksibilnost i empatiju pre- stand the complexity of human health,
ma ljudima dok mlađi liječnici u slu- including their own, and increased their
flexibility and empathy towards people,
čaju vlastitih psihičkih teškoća, češće
whereas younger doctors, in case of their
strahuju od stigme i gubitka profesio-
own mental difficulties, are more likely to
nalnog statusa (42,43). U našem uzor-
fear stigma and the loss of professional
ku to međutim nije slučaj. Vjerojatno
status (42, 43). In our sample, however,
su kod nas u igri i drugi čimbenici, po-
this pattern does not seem to hold true.
put organizacije i povezanosti raznih
Other factors, such as the organization
službi primarnog i sekundarnog nivoa and integration of various services with-
zdravstvenog sustava. in the primary and secondary levels of
the healthcare system, might play a role
Stavovi liječnika obiteljske medicine
in shaping these attitudes in our context.
o traženju stručne psihološke pomoći
ne razlikuju se ovisno o spolu liječni- The attitudes of family medicine doctors
ka što je sukladno rezultatima recen- towards seeking professional psycho-
tnih istraživanja (43,44). No istraživa- logical help do not differ based on their 25
 Izvorni znanstveni članak

nja starijeg datuma pokazivala su da gender, which is in accordance with the

muškarci imaju manje predrasuda i results of recent research (43, 44). How-
lakše traže pomoć, dok je u nekim re- ever, older studies indicated that men
centnijim istraživanjima nađena veća were less prejudiced and were more like-
sklonost traženju psihološke pomoći u ly to seek help, while some more recent
studies have found a greater inclination
ženskih ispitanika. Kao razlog navodi
towards seeking psychological help
se svjesnost žena o osobnom emoci-
among female participants. The reason
onalnom životu, prepoznavanju tuđih
cited for this change is that women are
emocionalnih stanja kao i otvorenija
more aware of their own emotional lives,
komunikacija (43,44,45). Ova razlika u
can recognize the emotional states of
rezultatima može značiti i da se mije-
others’, and tend to engage in more open
njaju stavovi žena i muškaraca prema
communication (43, 44, 45). This differ-
psihološkoj pomoći vjerojatno kroz ence in results may also indicate that
drugačije obrasce odgoja unatrag za- the attitudes of both women and men to-
dnjih desetljeća. wards psychological help are changing,
likely influenced by evolving upbringing
Stavovi LOM o traženju stručne psiho-
patterns over the past decades.
loške pomoći se ne razlikuju ovisno
o tome jesu li ili nisu polazili neku The attitudes of family medicine doctors
od edukacija iz psiholoških metoda towards seeking professional psycholog-
liječenja. Koliko god kontradiktorno ical help do not differ based on wheth-
izgledalo, ovo je sukladno rezultatima er they have undergone any training in
istraživanja zdravstvenih radnika u psychological treatment methods. As
Ujedinjenom Kraljevstvu (45). S druge contradictory as it may seem, this finding
aligns with the results of research among
strane istraživanja opće populacije go-
healthcare professionals in the United
vore da sklonost traženju psihološke
Kingdom (45). On the other hand, studies
pomoći raste proporcionalno stupnju
involving the general population show
edukacije (44,45). Mogući uzrok možda
that the tendency to seek psychological
leži u tome što organizacija obiteljske
help increases proportionally to the level
medicine ne prati društvene promjene:
of education (44, 45). The possible reason
brojčano skrbi o sve više, sve starijih for these results might lie in the fact that
pacijenata, a time je vrijeme za paci- the organization of family medicine has
jenta kratko i nedovoljno i oni više not kept pace with societal changes: the
nisu u mogućnosti dodatno djelovati increasing number of elderly patients
preventivno, savjetodavno, ili planirati has led to limited and insufficient time
kompleksne tretmane, odnosno provo- that can be dedicated for each patient,
26 diti praksu po biopsihosocijalnom mo- making it difficult for doctors to en-
Psihoterapija 2023.; vol. 37, br. 1-2: 3-36

delu koji su edukacijom usvojili (46). gage in additional preventive measures,

Ipak, većina LOM ipak ističe potrebu counselling, or complex treatment plan-
za boljom edukacijom iz psiholoških ning. As a result, they may not be able
metoda jer smatraju da bi to poboljšalo to fully implement the biopsychosocial
kvalitetu njihovog rada s pacijentima model they learned through education
(46). Nonetheless, the majority of family
(47).
medicine doctors emphasize the need for
Zapravo, među LOM postoji značajan better education in psychological meth-
interes za dodatnu psihoterapijsku ili ods, believing that it would enhance the
savjetodavnu izobrazbu što pokazu- quality of their work with patients (47).
ju i naši rezultati (48). LOM pokazuju
In fact, there is significant interest in
svjesnost potrebe za takvim interven-
pursuing additional training in psycho-
cijama i navode da je za gotovo 70 %
therapy or counselling methods among
njihovih pacijenata ona potrebna.(49). FMDs, as indicated by our results (48).
Moguće da oni svoju edukaciju zapravo FMDs demonstrate awareness of the
koriste za poboljšanje vlastitih psiho- need for such interventions and state
loških resursa za nošenje sa životnim that they are required for almost 70% of
i radnim stresorima (50). Rezultati their patients (49). It is possible that they
ovog istraživanja su pokazali da je ti- actually use their education to improve
jekom svog radnog vijeka velika veći- their own psychological resources nec-
na liječnika uputila svojeg pacijenta essary for coping with life and work-re-
sa somatskim smetnjama psihijatru, lated stressors (50). The results of this
no na svakodnevnoj bazi to je znatno study have shown that during their pro-
manje, a posebno je to izraženo kada je fessional career, a significant majority of
doctors have referred their patients with
riječ o grupama samopomoći. Rezulta-
somatic disorders to psychiatrists. How-
ti sličnih istraživanja vrlo su raznoliki,
ever, on a day-to-day basis, this number
od 5 do 40 % pacijenata sa somatskim
is considerably lower, especially when it
simptomima bude upućeno stručnja-
comes to self-help groups. The results of
cima mentalnog zdravlja (50,51,52).
similar studies are very diverse, stating
Raznovrsnost podataka možemo pove-
that 5 to 40% of patients with somatic
zati i s dijagnostičkim teškoćama, ali symptoms are referred to mental health
i s organizacijom i stupnjem suradnje professionals (50, 51, 52). The variability
između liječnika primarne medicine i in data could be associated with diag-
specijalističkim i suradnim službama nostic challenges, as well as with the
vezanim za mentalnozdravstvenu skrb organization and degree of collaboration
(53,54,55). Često se navodi teška dostu- between primary care physicians and
pnost usluga i osobna stigmatizacija specialized and collaborative services 27
 Izvorni znanstveni članak

mentalnih poremećaja kao kočnica za associated with mental health care (53,
posezanjem ka tretmanima. Moguće 54, 55). Frequently cited factors include
da u našem uzorku upravo teža dostu- the difficulty in accessing services and

pnost (dugo čekanje, nedovoljno ta- personal stigmatization of mental disor-

ders, acting as barriers to seeking treat-
kvih usluga dostupno kroz zdravstve-
ment. It is possible that in our sample,
ni sustav) ili nezadovoljstvo pruženim
the issue of limited accessibility (long
uslugama (kratkotrajan pregled koji
waiting times, insufficient availability
najčešće rezultira samo prepisivanjem
of such services within the healthcare
medikamenata bez upućivanja na system) or dissatisfaction with the pro-
neke druge psihološke tretmane) ima vided services (short appointments that
u tome svoju ulogu. Istraživanja poka- often result in prescription of medication
zuju da LOM ističu da 66 % somatskih without referrals for other psychological
pacijenata ima koristi od psiholoških treatments) play a role. Research shows
intervencija, no unatoč tome samo 9 % that FMDs emphasize the fact that 66% of
od njih ima kontinuirani tretman (26). somatic patients benefit from psycholog-

Kada je riječ o grupama samopomoći ical interventions, but despite this, only
9% of them receive continuous treatment
LOM najčešće navode da nisu upoznati
(26). When it comes to self-help groups,
s radom te vrste, da poslani pacijenti
FMDs mostly state that they are not fa-
nisu bili uključeni, a ponekad je razlog
miliar with this type of work, that the
i geografska odcijepljenost (npr. život
referred patients have not been involved,
na otoku) (56). Ovo zapravo dijelom go- and sometimes the reason for this lies
vori o slaboj suradnji primarnog i se- in geographical isolation (e.g. living on
kundarnog nivoa zdravstvene zaštite an island) (56). These results actually
pri čemu oni funkcioniraju zasebno indicate a weak collaboration between
odrađujući sve veći pritisak pacijenata the primary and secondary levels of
bez sadržajnijih povratnih informacija. healthcare, whereby they function sep-
Kada je riječ o vanzdravstvenom sek- arately, facing increasing patient pres-
sure without substantial feedback. When
toru poput grupa samopomoći, nepove-
it comes to the non-healthcare sector,
zanost i partikularizacija je još vidljivi-
such as self-help groups, disconnection
ja premda se baš takvim aktivnostima
and fragmentation is even more evident,
može značajno pojačati psihosocijalna
although such activities can significant-
komponenta zdravstvene usluge. Mo- ly enhance the psychosocial component
guće je i očekivanje da se takve usluge of healthcare services. There might also
organiziraju kroz zdravstveni sustav, exist an expectation that such services
što se u nekim zdravstvenim ustano- would be organized within the health-
28 vama i događa (psiholozi na određe- care system, which does happen in some
Psihoterapija 2023.; vol. 37, br. 1-2: 3-36

nim odjelima). No, to je i pokazatelj da healthcare institutions (psychologists in

naša organizacija zdravstvenog siste- specific departments). This is, however,
ma slabo koristi resurse i mogućnosti also an indicator that our organization of

društva u psihosocijalnom području i the healthcare system underutilizes the

society’s resources and opportunities in
da je razmišljanje o mentalno zdrav-
the psychosocial field and that the focus
stvenoj skrbi fokusirano isključivo na
on mental health care is primarily cen-
sekundarnu medicinsku zaštitu i to
tered around secondary medical care,
većinom u hospitalnom settingu.
predominantly within a hospital setting.

Studije pokazuju da liječnici opće prak- Studies have shown that general prac-
se smatraju da je suradnja sa stručnja- titioners believe that collaboration with
cima mentalnog zdravlja neophodna mental health professionals is neces-
za većinu pacijenata, no samostalno ne sary for most patients, but they do not
provode psihološke intervencije, a upu- conduct psychological interventions in-
ćivanja na tretmane su izuzetno rijetka dependently, and referrals for treatments
(27). Također se ističe želja za boljom are extremely rare (27). There is also a
desire for improved collaboration with
suradnjom sa psiholozima i ostalim
psychologists and other mental health
stručnjacima mentalnog zdravlja (30).
professionals (30). The application of
Primjena biopsihosocijalnog pristupa
the biopsychosocial approach clearly re-
očigledno traži rasterećenje liječnika
quires relieving family medicine doctors
obiteljske medicine u timu primarne within the primary healthcare team, pos-
zdravstvene zaštite, što je moguće uz sibly with the help of associate profes-
suradnju djelatnika srodnih orijenta- sionals. Increasing the number of nurses
cija. Povećanjem broja medicinskih and including mental health specialists
sestara i uključivanje stručnjaka men- in the family medicine team could create
talnog zdravlja u tim obiteljske medici- opportunities and a time-frame to work
ne otvorilo bi mogućnosti i vremenski with patients (27).

prostor za rad s pacijentima (27).

This study has shown that general prac-
titioners with longer work experience are
Ovo istraživanje je pokazalo da liječni-
more likely to refer patients with somat-
ci opće medicine koji imaju dulji radni
ic diseases to a psychiatrist, and those
staž češće upućuju pacijente sa somat-
who have undergone some training in
skom bolesti psihijatru, a oni s nekom
psychological methods are more likely
od edukacija na neki od psiholoških to refer patients for psychological treat-
tretmana te u grupe samopomoći. To se ments and to self-help groups. This coin-
poklapa s prethodno navedenim istra- cides with the aforementioned research
živanjima gdje dob i edukacija govore o where age and education correlate with 29
 Izvorni znanstveni članak

pozitivnijem pristupu službama men- a more positive attitude towards mental

talnog zdravlja (37,38,39). Moguće je da health services (37, 38, 39). It is possible
stariji liječnici imaju razvijeniju mrežu that older doctors have a more developed

prijateljskih i profesionalnih veza s ko- network of friendly and professional con-

nections with colleagues, allowing them
legama čime su u mogućnosti donekle
to bridge the gaps within the fragmented
premostiti fragmentaciju zdravstvenog
healthcare system to some extent. Those
sustava. Oni s edukacijom moguće su
who have undergone training may be
više senzibilizirani na dobrobit psiho-
more sensitized to the benefits of psy-
loške podrške njihovim pacijentima, a chological support for their patients and
moguće i da su bolje upoznati sa svim may also be more familiar with all forms
oblicima psihosocijalnih tretmana. of psychosocial treatments.

U našem uzorku najčešće se na psi- In our sample, patients with unspecified

hološke tretmane upućuju pacijenti s somatic symptoms and gastrointestinal
nespecificiranim somatskim simpto- symptoms are more commonly referred
mima i gastrointestinalnim simpto- for psychological treatment. Literature
data do not provide extensive possibil-
mima. Literarni podatci ne daju veliku
ities for direct comparison (54, 55, 57).
mogućnost usporedbe (54, 55, 57). Pre-
According to the results of some studies,
ma rezultatima nekih istraživanja naj-
patients most commonly referred for
češće upućeni na psihološke tretmane
psychological treatments are those with
su pacijenti koji boluju od nespecifici- unspecified somatic symptoms, oncology
ranih somatskih simptoma, onkološki patients and patients with HIV, which is
pacijenti i pacijenti oboljeli od HIV-a somewhat consistent with the findings of
što je donekle sukladno rezultatima this study (3).
ovog istraživanja (3).
In the case of non-specific somatic dis-
Kod nespecifičnih somatskih smetnji orders, there is often uncertainty regard-
uvijek ostaje nedoumica je li simp- ing whether the symptom is physical or

tom fizički ili psihički, te koju skrb psychological and what kind of care it re-
quires. Undifferentiated symptoms, often
zahtijeva. Nediferencirani simptomi,
involving pain syndromes, are likely un-
a najčešće se radi o bolnim sindromi-
derstood as such after extensive somat-
ma, vjerojatno su takvima shvaćeni
ic evaluation when no specific cause is
nakon opsežne somatske obrade kada
found, suggesting that there is a psycho-
nije nađen neki konkretni uzročnik i logical basis, often within a depressive
predmnijeva se psihološka podloga, cycle. However, the potential benefits
najčešće iz depresivnog kruga. No do- of psychological treatments of various
30 brobit psihološkog tretmana kod niza psychosomatic disorders, while theo-
Psihoterapija 2023.; vol. 37, br. 1-2: 3-36

psihosomatskih oboljenja, premda teo- retically recognized, are not frequently

rijski prepoznata, ne iskorištava se če- utilized. This is somewhat the case with
sto. Donekle je to u slučaju gastrointe- gastrointestinal diseases, but it is still
stinalnih bolesti, ali još je rijetko kada rare when it comes to cardiovascular, re-
je riječ o kardiovaskularnim, respira- spiratory or skin diseases. Patients with
HIV often face additional stigma in our
tornim ili kožnim bolestima. Pacijenti
country, which may be the reason for the
oboljeli od HIV-a kod nas imaju dodat-
rare referral for psychological treatments
nu stigmatizaciju što može biti uzro-
of any kind. Referral to self-help groups
kom rijetkog upućivanja na psihološke
probably also depends on the existence
tretmane bilo koje vrste. Upućivanje u
of such groups, their visibility and their
grupe samopomoći vjerojatno ovisi i o
methods of work. As previously men-
postojanju takvih grupa, njihovoj vid-
tioned, the official medical system in
ljivosti i njihovom načinu rada. Kako Croatia rarely engages in their activities,
smo već napomenuli, oficijelna medici- and the relatively weak volunteer scene
na u Hrvatskoj rijetko sudjeluje u njiho- does not favor this kind of involvement.
vim aktivnostima, a relativno slaba vo- Nevertheless, such groups are increas-
lonterska scena ne pogoduje ovakvom ingly being formed through non-profit
angažmanu. Ipak se kroz Neprofitne civic organizations and various other
građanske organizacije i razna druga organizational solutions, and are pre-
organizacijska rješenja sve češće osni- dominantly and for the longest periods
vaju takve grupe, a najčešće i najduže associated with patients with malignant
je to vezano za pacijente sa malignim psychosomatic illnesses.
psihosomatskim oboljenjima.
According to our knowledge, this is the
first study of this kind concerning the
Prema našem saznanju, ovo je prvo
attitudes towards referring somatic pa-
takvo istraživanje o stavovima pre-
tients for psychological treatment meth-
ma upućivanju somatskih pacijenata
ods among general practitioners in the
na psihološke metode liječenja među
PGC region. However, the study also has
liječnicima opće medicine u PGŽ. No
its limitations. The research was con-
studija ima i svoja ograničenja. Istraži-
ducted during a period when primary
vanje je provođeno u periodu kada su care physicians were still under signifi-
liječnici primarne zaštite još uvijek bili cant pressure due to the COVID-19 pan-
pod posebnim pritiskom radi pandemi- demic, which likely influenced the re-
je COVID-om pa je vjerojatno i to utje- sponse rate of doctors already burdened
calo na odaziv liječnika preopterećenih with daily responsibilities. Conducting
svakodnevnim obavezama. Online an- an online survey could have led to im-
keta mogla je rezultirati nepreciznošću precise responses that might have been 31
 Izvorni znanstveni članak

odgovora koja bi u klasičnoj varijanti, avoided in a traditional face-to-face ap-

licem u lice ispitivanja bila izbjegnu- proach. The relatively small number of
ta. Relativno mali broj ispitanika ne respondents does not allow for the gener-
omogućava generalizaciju rezultata, alization of the results, as well as the fact

kao ni činjenica da područne eduka- that regional educational institutions

may emphasize different aspects of dis-
cijske ustanove mogu davati naglasak
ease management, which means that a
na različite aspekte pristupa oboljenji-
model that works in one region might not
ma, tako da nešto što je model u jednoj
be the same in another. There is also the
regiji ne mora biti isti u nekoj drugoj.
possibility that the FMDs who participat-
Postoji i mogućnost da su LOM koji se
ed in the survey are actually those who
jesu odazvali anketi zapravo oni koji i are more attuned to the psychological
inače imaju više senzibiliteta za psiho- component of the disease. The effort not
lošku komponentu bolesti. Nastojanje to make the measuring instrument too
da instrumentarij ne bude preopsežan extensive resulted in limitations in the
rezultiralo je ograničenjima u uzročno cause-and-effect analysis.
posljedičnoj analizi.

CONCLUSION
ZAKLJUČAK
The results of this study indicate that
Rezultati ovog istraživanja ukazuju da despite the “organic” approach, the psy-
je unatoč „organskom“ djelovanju, psi- chological perspective is significantly
hološki spektar promišljanja značaj- present in the work of FMDs. Howev-
no zastupljen u radu LOM-a. No sama er, education alone is not sufficient to

edukacija nije dostatna za promjenu change their approach unless it is sup-

ported by the healthcare organization.
načina djelovanja ako nije podržana
Nevertheless, the interest in addition-
organizacijom zdravstvene skrbi. Ipak,
al training in psychological treatment
interes za dodatnu edukaciju iz psiho-
methods suggests that FMDs see this as
loških metoda liječenja pokazuje da
an improvement for their practice.
LOM u tome vide boljitak za svoj rad.
On the other hand, collaboration across
S druge strane, suradnja svih nivoa all levels of healthcare and non-health-
zdravstvenog i vanzdravstvenog su- care systems, although nominally en-
stava, premda se nominalno potiče, u couraged, remains inadequate, and the
stvari nije dostatna, a šira organiza- broader organization and communi-
cija i na zajednicu orijentirana skrb ty-oriented care for mental health are
32 za mentalno zdravlje još je vrlo redu- still very limited. Clearly, there is consid-
Psihoterapija 2023.; vol. 37, br. 1-2: 3-36

cirana. Evidentno je da ima još puno erable room for education and organiza-
prostora za edukaciju i organizaciju tion of health care that would result in
zdravstvene skrbi koja bi rezultirala the implementation of a biopsychosocial
primjenom biopsihosocijalnog pristu- approach and increase the integration of
pa i većom uključenošću psiholoških psychological interventions for patients
intervencija kod somatskih pacijenata. with somatic conditions.

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