Debate this: Is it my job to treat stress, or should I defer out?

By Elizabeth Pratt | Fact-checked by Barbara Bekiesz

Published April 23, 2025

Key Takeaways

Industry Buzz

“The challenge is when patients have more severe problems or pervasive problems affecting other parts of their lives. We want to get them in to see mental health professionals, [but] there's an inadequate supply.” – David Cutler, MD, board-certified family medicine physician, Providence Saint John’s Health Center, Santa Monica, CA
“Integrated care, where all specialties are becoming more aware of the importance of working at the intersection of medical and mental health, is becoming the norm more than the exception.” – Gregory Nawalanic, PsyD, clinical psychologist at The University of Kansas Health System

Stress can weave its way through your entire body, impacting every system from your immunity to your heart health to your digestion and more. ^[] So, when it comes to patient care, who is responsible for treating and managing stress?

“As with other health problems, it begins with primary care, and we are addressing [stress] constantly,” says David Cutler, MD, a board-certified family medicine physician at Providence Saint John’s Health Center in Santa Monica, California. “The challenge is when patients have more severe problems or pervasive problems affecting other parts of their lives. We want to get them in to see mental health professionals, [but] there's an inadequate supply of mental healthcare professionals to take care of them.”

“A lot depends on the severity of the problems and how long it's been going on and the overall condition of that patient. If they're coping with it adequately, but they still feel that there are some anxiety or depression or sleep issues, very often these can be managed by their primary care physician. Other times, if the patient experiences problems that have been lasting longer, they're more severe, then it would be appropriate to refer them elsewhere," Dr. Cutler says.

Gastros, take note

Ashkan Farhadi, MD is a board-certified gastroenterologist at MemorialCare Orange Coast Medical Center in Fountain Valley, CA. He says stress management is an essential component of his work caring for patients with IBS.

“[I] put my main emphasis on education, because that's the best thing that helps patients. And one of those things that is major [is] stress management,” he tells MDLinx. “The only place that you don't have stress is 6 feet under… The issue is not to get rid of the stress, because that's not practical. The issue is how to manage the stress."

Research suggests that chronic psychological stress is indeed a risk factor in developing IBS.^[] Dr. Farhadi advises his patients to manage stress through activities like meditation and exercise.

“Basically, you reboot your system, your GI tract… get a break throughout the day, and it starts functioning much better. This is one of the things I call stress management, and it's very effective for my patients,” he says.

Stress and oncology

In the field of oncology, stress is also believed to have a significant impact on patients with cancer.

Research suggests that chronic stress may cause cancer to worsen or metastasize.^[] Chronic stress can also impact the body’s ability to respond to chemotherapy and increase the likelihood of resistance to chemotherapy treatment. Stress can also inhibit the ability of the immune system to recognize and fight cancer cells.

However, evidence suggesting stress impacts survival in cancer patients is considered weak overall. Social support and successful management of stress has been shown to be beneficial in some people with cancer. Research suggests stress management improved clinical outcomes in patients with breast cancer.

The American Cancer Society notes that a diagnosis of cancer can have an impact on the mental health of not only the patient but on their families and caregivers. This can occur both during and after cancer treatment.^[]

Distress from a cancer diagnosis can impact the decision-making capacity of patients. Those with cancer who are feeling distressed may experience difficulties making decisions about treatment, taking necessary medications or making follow up appointments. Stress management strategies like psychotherapy, support or peer groups, medication, complementary therapies and mindfulness-based activities as potential ways patients with cancer can manage stress.^[]

A problem of supply and demand?

The demand for specialized mental health care has been so significant since the COVID-19 pandemic that primary care providers have no choice but to fill that gap, Gregory Nawalanic, PsyD, a clinical psychologist at The University of Kansas Health System, tells MDLinx.

“Psychologists and psychiatrists are always going to be at the heart of any discussion of stress because it falls within our wheelhouse,” he says. “But, I think primary care physicians feel a lot of pressure to prescribe something to patients to help them address their stress because they don’t feel they have the time nor money to seek appropriate care from a licensed mental healthcare provider.”

The benefits of integrated care

As for who is responsible for patient mental healthcare, Dr. Nawalanic argues that managing stress is an important element in all medical specialties.

“Integrated care, where all specialties are becoming more aware of the importance of working at the intersection of medical and mental health, is becoming the norm more than the exception,” he says. “Helping patients to manage their mental health and wellness is beneficial to any area of medical practice, so even merely including it in the discussion and making referrals to seek care, as necessary, will reap long-term benefits.”

“The time you save in not addressing it with a patient in a visit could cost you time in managing the subsequent issues that might arise," Dr. Nawalanic says.