Saturday, 27 April 2013

The biopsychosocial model of disease

The biopsychosocial model of disease existed in my notes... an excuse to get out the colouring crayons and draw a diagram, but ultimately another collection of facts that needed to be digested then regurgitated in the summer exams, something to be fitted in around learning about the important stuff - the science.
But the biopsychosocial model has come alive for me recently, now I realise what an impact the later two components, psychological and social, can have on patients.


In the 1977 paper in Science, George Engel introduced the biopsychosocial model:
"The dominant model of disease today is biomedical, and it leaves no room within it's framework for the social, psychological and behavioural dimensions of illness. A biopsychosocial model is proposed that provides a blueprint for research, a framework for teaching and a design for action in the real world of health care."

Following some conversations on Twitter recently and from my own experience at medical school and now as a patient, I wanted to explore my thoughts on this model.



Twitter, in the wonderful way it does, recently introduced me to the Disabled Medic blog, which among many other great posts, has also explored the biopsychosocial model, and I would recommend a read. 

The biopsychosocial model shows the influence that emotions and social circumstances have on physical health, which is important. But while conversations about the model focus on the way it can be used by healthcare professionals (very important!), it needs emphasising that the model can provide a framework for patients to look at/after themselves. The model highlights the psychological and social causes of disease, but more optimistically, it can show that there are a range of treatments for disease, from the medical to the social and psychological. A diagnosis of a long-term health conditions is often simultaneous with loss of control. There are limitations to the success of medications, treatments and surgeries. And in receiving these, we are relatively passive as patients, no matter how engaged we are. The biopsychosocial model looks at our biological, psychological and social needs, and how these factors influence our overall health. Establishing that these factors affect our health is only the first step. As patients, when psychological and social factors are brought in to the equation, it becomes clear that we ourselves have some power to help ourselves. By framing our health in this more holistic way, as patients we are not as powerless as suggested by the medical model. Through self-management we can make positive changes to our own psychological and social situations, which can in turn benefit our physical biological health.

To return to the traditional ground of the model - healthcare professionals....
One strength of the model is that it places psychology side beside its (generally considered) more superior counter-part, biology. I hope that by seeing the biopsychosocial model in action, physicians can appreciate the detrimental psychological impact of a diagnosis, and the assumption of "it is all in the mind" can fall by the way side. By integrating all three elements, the model shows that neither is independent of the others, so it can't be all in the mind, because other factors, biological or social, will be involved to some degree.

For me personally, the biopsychosocial model makes me look at what a 'life' is. One of the attractions of medicine is saving lives. Without getting too deeply into philosophy or ethics, I just want to explore for a second what saving a life really means for me, as a patient. I still believe that A&E staff heroically save lives. But I have come to realise that a life is more than a swiggly line on a heart rate monitor. My counsellor has been just as heroic in saving my life, through addressing my emotions. My life is now something I can live, rather than endure. With saving lives being a key (and honourable) motivation among medical staff, it is important that we can allow them to save lives as often as possible, and in many different ways. It may not always be through emergency treatment in resuscitation, but if we embrace the biopsychosical model, they can save lives in many more ways.

When there is a limit to the effectiveness of the biological approaches to an ill person, and they can't be returned to the land of the healthy, medical science becomes unstuck. Within the biopsychosocial model, the issue of doctors not being able to do anything is slightly less. As I mentioned in my post about making the transition from medical student to patient, I went to medical school because I wanted to make people better. But I was only being taught one way to make people better - drugs and surgery. If we really embraces the biopsychosocial model, doctors could make a difference, even if their standard tools of drugs aren't available because they could turn to psychological and social support. This isn't to say that all clinicians have to be counsellors or social workers - far from it. But an awareness and appreciation of their contribution to the management of a patient is important, as well as an understanding of the basic principles and skills such as motivational interviewing.

In 2013, I don't think I can talk about social in this context without mentioning social media. It was not was Engel originally meant in 1977, but social media has become a vital social tool for patients to manage their health. Ignoring anxieties and postural problems associated with sitting at a screen seeing everyone else's photo-shopped lives, it is undeniable that social media is a big and good resource that can empower patients to take responsibility and manage their own health. To see the best examples in action, take a look at Michael Seres and his blog, Being a Patient Isn't Easy to see a whole new meaning to the social in biopsychosocial!

I am still very grateful for the biological expertise of my medical team. Don't get me wrong - it's a good place to start and I wouldn't be here writing this post today if it wasn't for the biological support. But with chronic illness, when you are past the dramatic relapses, the biological isn't enough.... 
The biology has allowed me to live, but its the psychological and social support I have received that has allowed me to live.


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19 comments:

  1. Brilliant piece of writing as always

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    1. Thank you!
      Made easier with such good social (media) examples to include! :)

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  2. Anya
    Powerful and true.
    The model you describe and live brings us closer to our nature - we are complex and our energy and vitality, our well being depends on the relationship between body mind and heart (and I would add spirit) In our work on releasing compassion we focus primarily on the power of self compassion as we ask people to think about a question:-

    what do you think and feel about the way you care for yourself?

    and we encourage the listener not to interrupt. This simple question can be very painful as many of us do not care well for ourselves and it is only in the stillness that we encounter our wounded selves.

    I struggle myself with the vigilance needed to take care of myself - I have discovered a simple writing practice (I call it here i am) - i light a candle twice a day, follow my breath and then write for 5 minutes about whatever arises 'in the now' - this means i am never more than a few hours from myself which somehow keeps me safe and in tune with what self compassion and care is for me.

    I wonder if you have seen the vision of the amazing people behind FutureHealth in Brighton?

    Here I am, writing to you!

    Thank you

    Andy

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  3. I think this is a wonderful, thoughtful and interesting post - and brings up many ideas for me around how we utilise the illness trajectory to ensure that we give people the best "life-saving" care possible (and enable them to save their own lives, too) at the right times. You are so right that life is not about only surviving, but about being able to live, and this really struck me:"with chronic illness, when you are past the dramatic relapses, the biological isn't enough" - to close the loop, if the social and the psychological aren't also looked after, the relapses come around again all too soon... the biological is impacted on by the social and psychological and each three inter-relate and are interdependent.

    Really integrating a biopsychosocial model into healthcare offers a more holistic way to interpret what "health" is and what "illness" is, but also offers a clearer way to think about working together - social care, psychologists, IAPT, primary care and secondary care, in a way that honours the need to fit care to the person's life and their experiences of illness at the specific instance in time and also over time - you can plan to engage with self-management activities (and learn meditation techniques or pick up social activities) when your tablets are sorted and you're on a more even part of your trajectory, and when you're really unwell, you can use your positivity, and your social connections to give you the strength to pull through and endure - whilst you receive the medical care needed. They inter-relate and can thus improve the outcomes of interventions of each kind by providing resources for the person to help them engage and live through any problems they have.

    Thanks for a wonderful post

    Cheryl

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    1. Thank you! Your comment was really interesting to read!

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  4. hi is there any way I could reference this for a uni assignment?

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    1. Hi, I'm delighted to hear it is useful for your uni assignment! There are various ways you can reference blogs in the way you would normally reference academic articles - try this > https://www.citethisforme.com/cite/blog
      Good luck with your assignment!
      Anya

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  5. Can I use the above figure for teaching purpose. You will be fully acknowledged. Thank you.

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  6. Of course, as long as you credit my blog and provide a link,
    Many thanks, and hope the teaching goes well.

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  7. This comment has been removed by the author.

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    1. This comment has been removed by the author.

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  8. Nice work but it would be nice to get references

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    1. Sorry, I'm not sure I understand your comment. If you wish reference the blog in your work, I happy for that. There aren't any references within the blog as it is my general thoughts and reflections.

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  9. Hi Anya,
    In the 21st Century 'biopsychosocial' is imho no longer sufficient to account for - understand disease, recovery, well-being, research, public engagement, self-care, interdisciplinary and integrated care (I could go on).

    A model is needed which includes the POLITICAL care (knowledge) domain and Hodges' health careeer model is open, free, easy to understand and yet is quite powerful.

    The blog below includes diverse examples of how the model can be applied plus related content. There is also a bibliography. I am studying the model at Lancaster University in Technology Enhanced Learning another blog theme:

    http://hodges-model.blogspot.co.uk/

    Kind regards to all,
    Peter Jones
    @h2cm

    ReplyDelete
  10. Hi Anya,
    In the 21st Century 'biopsychosocial' is imho no longer sufficient to account for - understand disease, recovery, well-being, research, public engagement, self-care, interdisciplinary and integrated care (I could go on).

    A model is needed which includes the POLITICAL care (knowledge) domain and Hodges' health careeer model is open, free, easy to understand and yet is quite powerful.

    The blog below includes diverse examples of how the model can be applied plus related content. There is also a bibliography. I am studying the model at Lancaster University in Technology Enhanced Learning another blog theme:

    http://hodges-model.blogspot.co.uk/

    Kind regards to all,
    Peter Jones
    @h2cm

    ReplyDelete
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