The Biopsychosocial Model 25 Years Later

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

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..

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.

DUALISM, REDUCTIONISM, AND THE DETACHED OBSERVER.

COMPLEXITY SCIENCE: CIRCULAR AND STRUCTURAL CAUSALITY.

COMPLEXITY SCIENCE: CIRCULAR AND STRUCTURAL CAUSALITY.

Interpretations, Language, and Causality. 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..

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..

THE BIOPSYCHOSOCIAL MODEL AND RELATIONSHIP-CENTERED CARE.

principles of biopsychosocial -oriented clinical practice.

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.

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.

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.‏.