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Saudi Diploma in Family Medicine Center of Post Graduate Studies in Family Medicine

The BiopsychsosocialThe BiopsychsosocialModelModel

Dr. Zekeriya Aktürkzekeriya.akturk@gmail.com

www.aile.net

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What do you understand from this phrase:

““Don’t treat the disease; treat Don’t treat the disease; treat the patient.”the patient.”

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Aim-Objectives

• Aim: At the end of this presentation, the participants will have knowledge of biopsychosocial medicine and believe on the importance of this model in PC.

• Objectives:– Can define systems approach

– Can define biopsychosocial model

– Is aware of the importance of social, psychological and existential factors on health

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• Symptomatic era : – First medicine; every finding a disease – Hipocrattes, Razi, Ibn Sina; the balance of blood, phlegm and bile

• Laboratory era– 1880; invention of Rabies virus

• Clinical era– Diseases have different course in different patients…

• Social medicine– 1848; “Because it is aiming to improve the health of the public medicine

should be regarded as a social science…” – “The illness of a person is not solely his/her problem. It will effect others

as well.”• Systems approach

– Engel 1980; “The human is a complex being; it is difficult to find a single cause for his disease”

• Biopsychosocial medicine

Ages of medicine

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• Symptomatic era : – First medicine; every finding a disease – Hipocrattes, Razi, Ibn Sina; the balance of blood, phlegm and bile

• Laboratory era– 1880; invention of Rabies virus

• Clinical era– Diseases have different course in different patients…

• Social medicine– 1848; “Because it is aiming to improve the health of the public

medicine should be regarded as a social science…” – “The illness of a person is not solely his/her problem. It will effect

others as well.”• Systems approach

– Engel 1980; “The human is a complex being; it is difficult to find a single cause for his disease”

• Biopsychosocial medicine

–“Don’t treat the disease; treat the patient”

Ages of medicine

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Is medicine really improving?

• Number of laboratory tests increased 33% from 1967 to 1972

– McGinnis 1976

• What about patient satisfaction??

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• Jane, 19 y• Doing sports professionally• Has knee injury. The orthopedician applies a treatment.

During the follow up visit there is muscle weakness and general symptoms (fatigue, sweating, neck pain). She doesn’t exercise. There is disagreement with the orthopedician.

• The family physician discusses the effect of the disease on Jane’s live. A conservative family. Education and success is very important in the family. Siblings very successful.

• The injury caused loss of self-esteem• Establishing insight to the disease and discussion

established adherence to therapy and she improved soon.

A random case

McWinney S. 68 ve 173. değiştirilerek

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Population

Family, small groups, culture

Individual

Neuro-endocrine Immune system

Organ systems

Tissues

Cells

Melecules

Systems hierarchy

Engel 1980

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Patients life before knee trauma

Population

Family, small groups, culture

Individual

Neuro-endocrine Immune system

Organ systems

Tissues

Cells

Melecules

Conservative

Religious education with a brother of academic success

Transition to adulthood, self-esteem due to success in athletism

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Effect of knee traumaPopulation

Family, small groups, culture

Doctor-Patient

Individual

Neuro-end. Immune sys.

Organ systems

Tissues

Cells

Melecules

EventKnee trauma

Release of medical resources

Crisis

Disrupture of life plan, immobility, pain, anger, depression, irritability

Disagreement, loss of communication

Excess autonomic nervous system activity

Tachycardia, sweating, weight loss

Joint trauma, muscle injury

Reaction to trauma

System changes

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Effect of changePopulation

Family, small groups, culture

Doctor-Patient

Individual

Neuro-end. Immune sys.

Organ systems

Tissues

Cells

Melecules

EventEstablishing therapeutic relationship

Release of rehabilitative resources

Resolving of crisis, understanding

Understanding the real reason of the problem, rearranging life objectives

Establishing communication, therapy

Return of weight and heart rate, improvement of knee functions

Surgical intervention, release of muscle tension

Improvement

System changes

Return of weight and heart rate, improvement of knee functions

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• Aim: to treat the knee problem and remove the physical pathology underlying the symptoms.

• Which is important but not enough

• What is needed?: understanding of the patients internal world

Biomedical model

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Another case

• 35 y, male

• Married

• 3 kids

• Laborer in a fabric

• Gets injured at work

• Unable to work for 3 months

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Systems Thinking

• Systematic thinking is often used by scientists. • It makes it easy to understand • For example:

– an occupational trauma may be due to inadequate tools (social), loss of attention (psychological) or drop of blood glucose (biological);

– causing organ injury (biological), stress (psychological) or loss of income (economical).

• However, isolating the problem is not applicable to general practice. A GP has to consider the complex relationship of problems

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Bio-Psycho-Social Factors

Psychological Factors•Anxiety

•Depression•...

Biologic Factors•Immune System

•Endocrine System•Organ Systems•Tissues

•…

Social Factors

•Community•Family•Culture

•...

ANI SMORG

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Inadequate organized

environment (social)

Drop in blood

glucose (biologic)

Inattentive (psychological

)

Occupational injury

Organ trauma

(biologic)

Drop in income(social)

Stress (psychological

)

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• It encourages the clinician to observe the feelings, life objectives, attitude towards the disease, social environment, biochemical and morphologic changes.

• The person is a complex of body, mind and social environment. Environmental and psychological conflicts are potential pathologies for the individual.

• Feelings can affect physiological functions of the body (Zegans, 1983).

• Instead of dealing primarily with biological factors, considering psychological and social factors as well will enable understanding disease processes.

The Biopsychosocial Model

Engel 1977

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• The characteristics of the discipline of general practice/family medicine are that it: – …k - deals with health problems in their

physical, psychological, social, cultural and existential dimensions.

http://www.woncaeurope.org/

Wonca Europe 2005

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The LEARN Model- Listen with empathy the patients view to his/her

problem- Explain the patient on his/her words the view

and opinions of the doctor- Acknowledge the differences between the

doctor and patients thoughts- Recommend a model integrating the patients as

well as doctors opinions- Negotiate to a common solution with medical,

ethic, legal acceptability covering the patients expectations

Berlin and Fowkes (1983)

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• "You can't get patients well unless you know their psychiatric, medical, and social problems. Don't send them out on a low salt diet for problem #1: heart failure, and problem #5: lives all alone, no heat in the house, cooks his own meals, is 85 and half blind. You don't need to be a cardiologist to know that this wont work."

http://www.annfammed.org/cgi/eletters/2/6/576

Larry Weed :

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• Which of the below is wrong regarding the psychosocial model?

a) The person is evaluated with his family and environment

b) There are multiple ethiologic dimenstions

c) It evaluates the person with his body, soul and social environment

d) It has a disease centered approach

Summary

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• What is the main reason medicine moved from the laboratory era to the clinical era?

• What is the main idea of the systems approach and how can GPs use it in patient care?

• Can you explain the LEARN acronym developed by Berlin and Fowkes?