Making the biopsychosocial model more scientific—its general and specific models, Smith, 2021

[Andy]

Some aver that the biopsychosocial (BPS) model is not fully scientific because it lacks a method to produce BPS information. To resolve this criticism, I propose that we think in terms of general and specific BPS models. What most understand to be the model is the general BPS model. It simply indicates that all patients be understood in biological, psychological, and social terms without specifying a method or sources of BPS information. Its fundamental function is to guide medicine away from the effete, 17th century disease-only model in clinical care, teaching, and research. Considerable population-based research data also support its scientific status. Less well understood, but of greater relevance to the clinician, is the specific BPS model, which describes the BPS features unique to an individual patient. The specific model, however, requires an interviewing method to achieve this, the method critics believe lacking.

In this article, I review how medical communication scholars have established a method to acquire individualized BPS data on each patient. Research identified the patient-centered interviewing (PCI) method to do this. After much progress over several decades, the field was able to test the PCI in several randomized controlled trials—and confirmed it to be evidence-based. Therefore, by definition, because the patient-centered interview defines the specific BPS model in each patient, the model itself is evidence-based. This means we now can, for the first time, identify a scientific BPS model for every individual patient. Joining this scientific support with much existing data for the general model, we now have a fully scientific BPS model.

Paywall, https://www.sciencedirect.com/science/article/abs/pii/S0277953620307875

 

[Trish]

The author of this has written a book called 'Smith's Patient Centered Interviewing'.
https://accessmedicine.mhmedical.com/content.aspx?bookid=501&sectionid=41021115

In the Preface he says (my bolding)

The Michigan State University (MSU) group, under the direction of this text's original author, Robert C. Smith, developed a behaviorally defined, replicable patient-centered method based on empirical evidence, literature review, consultation with others, and their own experiences.

The result was the 5-step, 21-substep method presented in Chapter 3. In a randomized controlled trial (RCT), the MSU group demonstrated that the method was easily learned, efficient, and replicable. In a subsequent RCT, using the approach as part of treating patients with medically unexplained symptoms, they demonstrated clinically significant improvement in multiple measures of patients' health status and very high levels of patient satisfaction. A subsequent pilot RCT corroborated these findings.

The 5-step patient-centered method became the first comprehensive, behaviorally defined, evidence-based method for teaching and learning the medical interview. In a typical outpatient encounter, no more than 3–6 minutes of patient-centered interviewing is necessary (additional time is needed for clinician-centered interviewing). Others have demonstrated that patient-centered practices do not add time to the visit.

 

[Sean]

This means we now can, for the first time, identify a scientific BPS model for every individual patient.

If it explains everything, it explains nothing. Infinite flexibility is not a desirable feature in a scientific model, BPS or otherwise.

Without reading the main text, I make a testable prediction that much circularity and unfalsifiability will be found therein.

 

[Mithriel]

The only way to make the BPS model more scientific is to find develop a testable theory of how it impacts the body. The FND work is trying to do that though it is full of gaps.

 

[John Mac]

Making the biopsychosocial model more scientific

What! How could the bps model be even more scientific? Impossible surely?

 

[rvallee]

"This is scientific because I like it" is quite the rhetoric-based 17th century argument. They use the thing they want to prove to prove that they are right. It's a perfectly circular argument. How do serious people who work in the field of health care not see that? The reviewers. The editors. No one really sees that this is a fully circular argument? Incredible.

If this is not a joke paper submitted to test the limits of what nonsense journals will publish, I cannot tell the difference.

 

[Jonathan Edwards]

Therefore, by definition, because the patient-centered interview defines the specific BPS model in each patient, the model itself is evidence-based. This means we now can, for the first time, identify a scientific BPS model for every individual patient.

Er no, there was a guy called Sigmund something who tried this 100 years ago.
Then a fellow called Karl used Sigmund's method as a definition of what science is not.

 

[Arnie Pye]

Making the biopsychosocial model more scientific

Isn't this like trying to put lipstick on a slug to make it pretty?

 

[Hoopoe]

Apophenia is the tendency to perceive meaningful connections between unrelated things. Especially when the person is told there is some hidden meaning to be discovered. That would seems to be a serious problem in this approach.

 

[Jonathan Edwards]

Maybe our species should have been called Homo apopheniensis

 

[Barry]

Making the biopsychosocial model more scientific

Now there's a confession if ever there was.

 

[Barry]

Isn't this like trying to put lipstick on a slug to make it pretty?

An alternative being, like trying to polish a turd.

The specific BPS model is obtained by evidence-based, patient-centered interviewing.

Because the interview is evidence-based, the specific BPS model is scientific.

That glib phrase "evidence-based" yet again. Low or very low quality evidence does not entitle you to start bragging about being evidence based.

 

[alktipping]

since when was 3 6 minutes long enough to take a decent patient history never mind adding the bs that these people seem to have swallowed whole .

 

[Sean]

That glib phrase "evidence-based" yet again. Low or very low quality evidence does not entitle you to start bragging about being evidence based.

If you are having to use such phrases in the sales pitch, chances are you don't have the evidence.

 

[Snowdrop]

What this paper along with the pile of other BPS papers needs is for some healthy mentally energetic person to come along and set up a youtube channel for debunking the fake science of BPS cure-alls for whatever ails you. *

Lots of material there. Maybe not altogether entertaining so maybe David Tuller can come in and rip up some paper and throw it about.

Or maybe a wild west theme with various olde-timey potions, lotions, salves and eye of newt jars as a backdrop.

And a really, really big rubber stamp to smack on the paper saying 'Fake Science'.

So let your imagination run loose with ideas -- the BPS ideologues / true believers certainly did.

And maybe beg the writers to get out and mingle with people outside their belief system sometime to gain some perspective. After the pandemic is over of course.

Or maybe it's time to call the FBI in to secure the compound.

*Apologies. I just can't take this stuff seriously any more. And I'll probably regret this attempt at humour in the morning.

 

[Hutan]

The author of this has written a book called 'Smith's Patient Centered Interviewing'.

From chapter 9:

Because personality manifests itself in relationships, it is part of the relationship story. Make your observations throughout the interview and identify the patient's dominant personality style as dependent, histrionic, obsessive, self-defeating, narcissistic, paranoid, or schizoid (or other types), as outlined in Chapter 8.

 

[shak8]

I'm having an ad hominen attack.

 

[Sean]

Because personality manifests itself in relationships, it is part of the relationship story. Make your observations throughout the interview and identify the patient's dominant personality style as dependent, histrionic, obsessive, self-defeating, narcissistic, paranoid, or schizoid (or other types), as outlined in Chapter 8.

Because we just know for sure that they do have a defective personality type. Yes sirree, no question at all about that. The diagnostician's task is merely to figure out which type it is.

 

[chrisb]

What if the diagnostician has a defective personality type which causes him to mis-evaluate his patients?

 

[Art Vandelay]

Because personality manifests itself in relationships, it is part of the relationship story. Make your observations throughout the interview and identify the patient's dominant personality style as dependent, histrionic, obsessive, self-defeating, narcissistic, paranoid, or schizoid (or other types), as outlined in Chapter 8.

A more scientific approach would be to identify each patient's personality style by referring to their astrological chart