Name: The Biopsychosocial Model 25 Years Later
Uploaded: 2022-03-27
Duration: 17 min 7 s
Description: The Biopsychosocial Model 25 Years Later. Principles, Practice, and Scientific Inquiry.

The Biopsychosocial Model 25 Years Later. Principles, Practice, and Scientific Inquiry. 

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The  Biopsychosocial  Model  25 Years Later

Principles, Practice, and Scientific Inquiry

Francesc   Borrell - Carrió , Anthony L.  Suchman , Ronald M. Epstein

GEORGE ENGEL’S LEGACY:. To understand and respond adequately to patients’ suffering and to give them a sense of being understood, clinicians must attend simultaneously to the biological , psychological , and social dimensions of illness. He offered a holistic alternative to the prevailing biomedical model.. 

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To understand and respond adequately to patients’ suffering and to give them a sense of being understood, clinicians must attend simultaneously to the  biological ,  psychological , and  social  dimensions of illness. He offered a holistic alternative to the prevailing biomedical model.

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GEORGE ENGEL’S LEGACY:. He formulated his model at a time when science itself was evolving from an exclusively analytic , reductionist , and specialized endeavor to become more cross disciplinary . Engel championed his ideas as a fundamental ideology, that tried to reverse the dehumanization of medicine and disempowerment of patients . His model struck a resonant chord with those sectors of the medical profession that wished to bring more empathy and compassion into medical practice. 

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He formulated his model at a time when  science  itself was evolving from an  exclusively analytic ,  reductionist , and specialized endeavor to become  more cross disciplinary . Engel championed his ideas as a fundamental ideology, that tried to reverse the  dehumanization of medicine and disempowerment of patients . His model struck a resonant chord with those sectors of the medical profession that wished to bring more  empathy  and  compassion  into medical practice

DUALISM, REDUCTIONISM, AND THE DETACHED OBSERVER. 

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DUALISM, REDUCTIONISM, AND THE DETACHED OBSERVER

Engel was responding to 3 main strands in medical thinking that he believed were responsible for dehumanizing care. First, he criticized the dualistic nature of the biomedical model, with its separation of body and mind. Second, Engel criticized the excessively materialistic and reductionist orientation of medical thinking. third element was the influence of the observer on the observed.

COMPLEXITY SCIENCE: CIRCULAR AND STRUCTURAL CAUSALITY. 

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COMPLEXITY SCIENCE: CIRCULAR AND STRUCTURAL CAUSALITY

Engel objected to a linear cause-effect model to describe clinical phenomena. Clinical reality is far more complex.

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Complexity and Causality: (one microbe, one illness)  There are usually multiple interacting causes and contributing factors. Structural Causality: It describes a hierarchy of unidirectional cause-effect relationships necessary causes, precipitants, sustaining forces, and associated events.

Interpretations, Language, and Causality. Causal attributions have the power to create reality and transform the patient’s view of his/her own world.. 

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Causal attributions have the power to create reality and transform the patient’s view of his/her own world.

TOWARD A RELATIONSHIP-CENTERED MODEL. 1. Power and Emotions in the Clinical Relationship : Patient-centered, relationship-centered, and client-centered, are approaches propose that arriving at a correct biomedical diagnosis is only part of the clinician’s task; they also insist on interpreting illness and health from an intersubjective perspective by giving the patient space to articulate his or her concerns, finding out about the patient’s expectations, and exhorting the health professional to show the patient a human face.. 

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1. Power and Emotions in the Clinical Relationship : Patient-centered, relationship-centered, and client-centered, are approaches propose that arriving at a correct biomedical diagnosis is only part of the clinician’s task; they also insist on interpreting illness and health from an  intersubjective  perspective by giving the patient space to articulate his or her concerns, finding out about the patient’s expectations, and exhorting the health professional to show the patient a human face.

2. Implications for Autonomy: Most patients desire more information from their physicians, fewer desire direct participation in clinical decisions, and very few want to make important decisions without the physician’s advice and consultation with their family members. The ideal, might be “autonomy in relation” .. 

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2. Implications for Autonomy: Most patients desire more information from their physicians, fewer desire direct participation in clinical decisions, and very few want to make important decisions without the physician’s advice and consultation with their family members. The ideal, might be “autonomy in relation” .

3. The Social Milieu (environment) : There is an ecological dimension of each encounter—it is not just between patient and physician, but rather an expression of social norms. 4. Caring, Paternalism, and Empathy: The physician who sees his or her role as nothing more than a technical adviser can regard empathy as a useless effort that has no influence on clinical practice.. 

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3. The Social Milieu (environment) : There is an ecological dimension of each encounter—it is not just between patient and physician, but rather an expression of social norms. 4. Caring, Paternalism, and Empathy: The physician who sees his or her role as nothing more than a technical adviser can regard empathy as a useless effort that has no influence on clinical practice.

THE BIOPSYCHOSOCIAL MODEL AND RELATIONSHIP-CENTERED CARE. 

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THE BIOPSYCHOSOCIAL MODEL AND RELATIONSHIP-CENTERED CARE

The practical application of the  biopsychosocial  model, which we will call  biopsychosocially  oriented clinical practice  does not necessari ly evolve from the constructs of interactional dualism or circular causality. Rather, it may be that the content and emotions that constitute the clinician’s relationship with the patient are the fundamental principles of  biopsychosocial -oriented clinical practice, which then inform the manner in which the physician exercises his or her power.

principles of biopsychosocial -oriented clinical practice. 

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principles of  biopsychosocial -oriented clinical practice

1.Calibrating the Physician The  biopsychosocial  model calls for expanding the number and types of habits to be consciously learned and objectively monitored to maintain the centrality of the patient 2. Creating Trust the physician must know how to recognize and when to express his or her own emotions, sometimes setting limits and boundaries in the interest of preserving a functional relationship.

3. Cultivating Curiosity Empathic curiosity allows the clinician to maintain an open mind and not to consider that any case is ever closed. If the patient does not surprise us today, perhaps he or she will tomorrow. 4. Recognizing Bias The grounding of medical decisions based on scientific evidence while also integrating the clinician’s professional experience is now a well-accepted tenet of the founders of the evidence-based medicine movement.. 

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3. Cultivating Curiosity Empathic curiosity allows the clinician to maintain an open mind and not to consider that any case is ever closed. If the patient does not surprise us today, perhaps he or she will tomorrow. 4. Recognizing Bias The grounding of medical decisions based on scientific evidence while also integrating the clinician’s professional experience is now a well-accepted tenet of the founders of the evidence-based medicine movement.

5.Educating the Emotions 6. Using Informed Intuition The role of intuition is central. 7. Communicating Clinical Evidence Evidence should be communicated in terms the patient can understand. 

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5.Educating the Emotions 6. Using Informed Intuition The role of intuition is central. 7. Communicating Clinical Evidence Evidence should be communicated in terms the patient can understand

The value of the biopsychosocial model has not been in the discovery of new scientific laws, as the term “new paradigm” would suggest, but rather in guiding parsimonious application of medical knowledge to the needs of each patient. In the 25 years that have elapsed since Engel first proposed the biopsychosocial model, two new intellectual trends have emerged that could make it even more robust.. 

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The value of the  biopsychosocial  model has not been in the discovery of new scientific laws, as the term “new paradigm” would suggest, but rather in guiding parsimonious application of medical knowledge to the needs of each patient. In the 25 years that have elapsed since Engel first proposed the  biopsychosocial  model, two new intellectual trends have emerged that could make it even more robust.

FURTHER DEVELOPMENT OF THE BIOPSYCHOSOCIAL MODEL

FURTHER DEVELOPMENT OF THE BIOPSYCHOSOCIAL MODEL. 

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First, we can move beyond the problematic issue of mind-body duality by recognizing that knowledge is socially constructed. To some extent, such categories as “mind” or “body” are of our own creation. They are useful to the extent that they focus our thinking and action in helpful ways ( eg , they contribute to health, well-being, and efficient use of resources), but when taken too literally, they can also entrap and limit us by creating boundaries that need not exist.

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Second, we can move beyond the multidimensional and  multifactorial  linear thinking to consider complexity theory as a more adequate model for understanding causality, dualism, and participation in care. Complexity theory shows how, it is often impossible to know all of the contributors to and influences on particular health outcomes.

Reference. Borrell-Carrió , F., Suchman , A. L., & Epstein, R. M. (2004). The biopsychosocial model 25 years later: principles, practice, and scientific inquiry. The Annals of Family Medicine , 2 (6), 576-582.‏. 

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Borrell-Carrió , F.,  Suchman , A. L., & Epstein, R. M. (2004). The  biopsychosocial  model 25 years later: principles, practice, and scientific inquiry.  The Annals of Family Medicine ,  2 (6), 576-582.‏