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(More customer reviews)I think there is a lot to learn from the Biopsychosocial model. But it is perhaps most instructive regarding what's wrong with the medical establishment. It is a clear example that doctors need to be taught what just about everybody else knows intuitively.
To briefly summarize the Biopsychosocial model, it states that people's overall state of health is not just a simple matter of biological cause and effect, but rather is influenced by complex interactions between factors across the spectrum from microscopic biochemical events all the way to cultural and political forces. (Wow, no kidding? It would take a brain surgeon or a rocket scientist to not know this.) Come to think of it, that wasn't a brief summary. That is actuality it in its entirety. In fact, I may even have expanded on it.
It is informative about the process by which people become doctors, that self-perpetuating establishment of near-autistic, first-in-the-class-to-hand-in-the-test, anti-intellectual, hyper-competitive, over-achievers.
My background was in anthropology. There is plenty to criticize about the social sciences, but I'll save that for another format. After years of study in Biological and Cultural Anthropology, I switched to medicine, and felt like I had taken a trip backwards in a time machine. It was first evident in the little things, like referring to humanity as "Man" as if it was 1950. It came up in more insidious ways, for example when discussing genetic predispositions for diseases without awareness of the concept that races do not fall in neat, discrete categories. There was a two hour course in Medical anthropology, taught from 3 to 5 PM on a Friday afternoon by a professor who probably read his last anthropology text in the early seventies. As he lamented the loss of exotic primitives, I almost expected to hear him say "noble savages." And this was in Rochester, the home of the Biopsychosocial. The term was thrown around as often as possible in the first two years, in the classroom, and then disappeared entirely during the final two clinical years.
The problem with the Biopsychosocial model, besides its obviousness and its unwieldy title, is that it has no connection to the realities of the modern practice of medicine. The only practitioners truly doing Biopsychosocial medicine are the alternative medicine practitioners, and that is precisely why their popularity is growing (it obviously has nothing to do with the efficacy of their evidence-resistant treatments). They call it a `holistic approach,' another wet dream of a contrivance that could only be truly applied by an omniscient provider with infinite time.
Anyway, I don't mean to defecate on this book. It is actually an interesting book and I recommend it. I won't pretend I read it cover to cover but many of the individual essays in it are quite readable and thoughtful at times. I've worked with some of the contributors so I don't want to get too specific, I think they're all pretty decent cats (except for one, yeah you know who you are). So go out and buy this book, learn the history of Biopsychosocial medicine, and be a wiser clinician. Or be a wiser patient.
And please excuse my cynical ramblings. I promise, I'm really a Biopsychosocialist in my bleeding heart.
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For thousands of years, Western culture has dichotomized science and art, empiricism and subjective experience, and biology and psychology. In contrast with the prevailing view in philosophy, neuroscience, and literary criticism, George Engel, an internist and practicing physician, published a paper in the journal Science in 1977 entitled 'The Need for a New Medical Model: A Challenge for Biomedicine.' In the context of clinical medicine, Engel made the deceptively simple observation that actions at the biological, psychological, and social level are dynamically interrelated and that these relationships affect both the process and outcomes of care. The biopsychosocial perspective involves an appreciation that disease and illness do not manifest themselves only in terms of pathophysiology, but also may simultaneously affect many different levels of functioning, from cellular to organ system to person to family to society. This model provides a broader understanding of disease processes as encompassing multiple levels of functioning including the effect of the physician-patient relationship. This book, which contains Engel's seminal article, looks at the continuing relevance of his work and the biopsychosocial model as it is applied to clinical practice, research, and education and administration. Contributors include: Thomas Inui, Richard Frankel, Timothy Quill, Susan McDaniel, Ronald Epstein, Peter Leroux, Diane Morse, Anthony Suchman, Geoffrey Williams, Frank Degruy, Robert Ader, Thomas CampbelL, Edward DecI, Moira Stewart, Elaine Dannefer, Edward Hundert, Lindsey Henson, Robert Smith, Kurt Fritzsche, Manfred Cierpka, Michael Wirsching, Howard Beckman, and Theodore Brown.
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