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One of my third-year medical students recently commented, “Why do you see somuch psych in your practice? Why don’t you just refer all of these patients with depression, anxiety, and stress to a psychiatrist”? The same student later commented, “I’m impressed that you spent time motivating your patient to take better care of himself in managing his diabetes and metabolic syndrome—when do we learn those techniques in medical school”? As in many of my previous forewords for the Primary Care: Clinics in Office Practice series, I have stated the challenges of teaching the necessary tools and knowledge to address many complex medical and psychosocial issues within 4 years of medical school and 3 years of primary care residency. While this continues to be a formidable challenge, the proverbial bar becomes raised even higher day after day in meeting the needs of our patients—without simply referring our patients to a specialist when we can be well equipped to diagnose and treat common psychiatric conditions. Appropriate psychiatric treatment requires longitudinal care, sequential assessments, hours of compassionate listening, and the ability to motivate people to make positive changes in their lives. Primary care providers are poised to accept this challenge. This issue of Primary Care: Clinics in Office Practice dedicated to psychiatric care in the primary care setting highlights many salient components of psychiatric care requisite for daily practice. The issue commences with detailing the important conceptual framework of how psychiatric care is integrated through multidisciplinary teams, a necessary construct to understand and utilize relative to our resources. Articles outlining motivational interviewing techniques, cognitive behavioral therapy, and mindfulness techniques contain strategies that clinicians can easily implement and teach that will improve outcomes. Many of the common psychiatric diagnoses seen in primary care are explored in detail, including depression, anxiety, bipolar disorder, personality disorders, autism spectrum disorders, and psychiatric emergencies. A dedicated article highlighting pharmacotherapy is rich in practical information that is always evolving.

In reading the articles for this volume of Primary Care: Clinics in Office Practice dedicated to practice management, I became nostalgic thinking about when I was applying to medical school. As for most applicants, colleges and universities require a personal statement of some form where we highlight our passions for entering the field of medicine. Then, there is a usually an interview process with a panel of professors dubbed the “Pre-Professional Advisory Committee,” or some other very similar moniker. In 1991, when I was invited to discuss my dreams of becoming a physician and convince the committee that I was a suitable candidate for admission to medical school, I was asked, “what will be the greatest challenge facing physicians in the coming years”? My answer was both insightful and foreshadowing: “the physician of the future will not only need to be adept at medical science and current in knowledge with newmedications, therapies, and technologies, but will also require a keen understanding of the business aspects of medicine with respect to cost-effective provisions of care and integration between various levels of providers.” Not realizing that my answer would serve as the proverbial “lightning rod,” a member of the committee retorted, “I recommend that this committee NOT support your application to medical school, because medicine is a science, NOT a business!” Hanging my head low, I figured I had blown my chances for endorsement as a medical school applicant. Perhaps not ironically, we ALL now recognize that medicine, for better or for worse, is an exceptionally complicated business paradigm, and a national crisis requiring the need for immediate and powerful reform due to rapidly escalating costs. In this volume of Primary Care: Clinics in Office Practice, impressively the topics of utilizing international medical graduates and integrating behavioral medicine, palliative care, and pain management in primary care offer guidelines for augmenting our daily practices. Every aspect of practice management is now dependent on electronic medical records, as most practices and clinicians use some form of this on a daily basis; yet, the challenges of ensuring adequate and appropriate documentation to