The Biopsychsosocial
Model
Introduction to Primary Care:
a course of the Center of Post Graduate Studies in FM
PO Box 27121 – Riyadh 11417
Tel: 4912326 – Fax: 4970847
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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:
–
–
–
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Can define systems approach
Can define holistic health care model
Can define biopsychosocial model
Is aware of the importance of social, psychological and
existential factors on health
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A random case
• A young women of 19 injured her knee while playing baseball and
was admitted to hospital for surgery. When seen for follow-up by the
surgeon, she showed weakness and muscle wasting in the leg and
complained of a number of general symptoms (fatigue, sweating, pain
in the neck). When the surgeon suggested that she was not doing her
exercises, she became hostile and angry. Eventually she returned to
her family physician, who found her with severe muscle wasting and
still complaining of the same general symptoms. After excluding some
physical causes of her symptoms, the doctor encouraged her to talk
about the impact of the illness on her life. She had had a strongly
religious upbringing, with emphasis on academic and athletic
achievement. Having siblings with high academic abilities, she had
based her self esteem on athletic achievements, which she now saw
threatened by her injury. Given some insight into her problem and an
opportunity to discuss it with the doctor, she began to cooperate
with
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her physiotherapist and returned to fully activity.
Ages of medicine
•
•
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•
•
•
Symptomatic era
Laboratory era
Clinical era
Social medicine
Systems approach
Biopsychosocial medicine
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Symptomatic era
• Hippocrates (460-377 BC)
• Aristotle (384-322 BC)
Warmth
AIR
FIRE
Dry
Humidity
WATER
SOIL
Cold
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Symptomatic era
• Claudius Galenus (M 130-231)
• Abubekir Razi (M 865-962)
• Ibn-i Sina (M 980-1037)
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Laboratory era
•
•
•
•
•
•
•
Andreas Vesalius (1514-1564) Anatomy
Marcello Malpighi (1628-1698) Histology
G.B.Morgagni (1628-1771): Patology
Claude Bernard (1813-1878) Physiology
Roudolph Virchow: (1821-1902) Cell path.
Louis Pasteur (1825-1895): Bacteriology
Emil Fischer (1852-1919) and Paul Ehrlich
(1854-1915) Biochemistry
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Clinical era
• “It is more important to have information on
the person who has the disease rather than
the type of the disease.”
Sir William Osler (1904)
• Treat the patient, not the disease!
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Social medicine
• “Social medicine deals with investigating
the relationships between medicine and the
population and uses medical services for the
wellness of the population without
depending on any doctrine or ideology."
Dr. Jules Rene Guerin, 1848
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Systems approach
• The human is in fact a very complex creature.
• It is not always possible to find a single causative
factor for human diseases.
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Systems hierarchy (Engel 1980)
Population
Family, small groups, culture
Individual
Neuro-endocrine Immune system
Organ systems
Tissues
Cells
Melecules
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Patients life before knee trauma
Population
Family, small groups, culture
Individual
Conservative
Religious education with a
brother of academic success
Transition to adulthood, selfesteem due to success in athletism
Neuro-endocrine Immune system
Organ systems
Tissues
Cells
Melecules
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Effect of knee trauma
Population
Event
Knee trauma
Family, small groups, culture
Doctor-Patient
Individual
Neuro-end. Immune sys.
Organ systems
Tissues
Cells
Melecules
System changes
Release of medical resources
Crisis
Disagreement, loss of communication
Disrupture of life plan, immobility,
pain, anger, depression, irritability
Excess autonomic nervous system activity
Tachycardia, sweating, weight loss
Joint trauma, muscle injury
Reaction to trauma
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Effect of change
Event
Establishing
therapeutic
relationship
System changes
Population
Release of rehabilitative resources
Family, small groups, culture
Resolving of crisis, understanding
Doctor-Patient
Establishing communication, therapy
Individual
Understanding the real reason of the
problem, rearranging life objectives
Neuro-end. Immune sys.
Return of weight and heart rate,
improvement of knee functions
Organ systems
Return of weight and heart rate,
improvement of knee functions
Tissues
Cells
Melecules
Surgical intervention,
release of muscle tension
Improvement
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Systematic 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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Biomedical model
• 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
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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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The Holistic Health Care Model
• Emphasizes personal development assuming
– All types of health and disease are psychosomatic
– There is a communication between body, mind and soul
– Diseases arise from inability to adapt to different situations
• Gives importance to personal care, education
and prevention
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–
–
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Natural nutrition,
Herbal therapy,
Acupuncture
…
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The Biopsychosocial Model (Engel 1977)
• 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.
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Bio-Psycho-Social Factors
Biologic
Factors
•Immune
System
•Endocrine
System
•Organ
Systems
•Tissues
•…
ORG ANI SM
Social
Factors
•Community
•Family
•Culture
•...
Psychological
Factors
•Anxiety
•Depression
•...
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Another case
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35 y, male
Married
3 kids
Laborer in a factory
Gets injured at work
Unable to work for 3 months
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Inadequate
organized
environment
(social)
Drop in
blood
glucose
(biologic)
Inattentive
(psychological)
Drop in
income
(social)
Occupationa
l injury
Organ
trauma
(biologic)
Stress
(psychological)
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LOSS of JOB
(A social factor)
DEPRESSION
(Psychological)
P. ULCER AGGREVATION
(Biological factor)
For an effective patient management, the interaction
between all factors should be taken into acount 24
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
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Berlin and Fowkes (1983)
Summary
•
a)
b)
c)
d)
Which of the below is wrong regarding the
psychosocial model?
The person is evaluated with his family and
environment
There are multiple ethiologic dimenstions
It evaluates the person with his body, soul
and social environment
It has a disease centered approach
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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?
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