ME/CFS and the biopsychosocial model: a review of patient harm and distress in the medical encounter - Geraghty et al. 2018

Hutan said:
The paper is much better than the abstract and should be of use in the forth-coming NICE review. It clearly shows that patients are experiencing and reporting harm as a result of the BPS model.

The term 'bio-psycho-social model' can be interpreted so many ways, most of which seem perfectly sensible, progressive and so very hard to argue against. But, as Keith points out, the BPS model for CFS, is in fact narrow, prescriptive and dismissive of patients' experiences.

I wonder if we should not accept the view of the Wessely school as being appropriately termed a BPS model. Rather, it is a Psychosomatic model or a Dysfunctional Beliefs and Behaviours model. Perhaps if we called it what it actually is, the harm that flows from it would be easier to see.

edit for a typo
Click to expand...
Yes, it's as if SW, MS, et al have this way of hijacking the names of things that make sense, and then corrupting them to a nonsensical form of their own manipulative choosing ... but still use the same name. CBT, BPS, etc. A bit like the way invaders throughout history have superimposed their own ceremonies and festivals onto those pre-existing ones of indigenous populations, so the subterfuge is less obvious. And in more modern times when a company is bought out, and a brand name is perpetuated even though the product is by then completely different. This has invariably been a conscious strategy, and I'm sure with SW/MS/etc it is the same.
 
I think the main problem with models like these (which others have basically already pointed out, and this paper demonstrates) is that they allow everyone to make assumptions, explicit or not so explicit, about the conditions and the sufferers that go much further than what evidence actually shows. Categories like functional disorders and the biopsychosocial framework are almost true by their definitions (ie. unexplained illness or biological and psychological factors both being relevant - like almost everything), but many assumptions and implications are attached to the use of them which aren't properly supported. It's difficult to stop their use though, because the models are true by their definitions.
 
Last edited:
http://www.meassociation.org.uk/201...cial-model-by-dr-keith-geraghty-29-june-2018/

MEA page with a summary by Keith Geraghty

Dr Geraghty kindly agreed to provide a summary explanation of what his latest research discovered:

“ME/CFS patients consistently report problems with accessing good quality medical care and support. Many recount distressing encounters with doctors. Despite such consistent anecdotal reports, there has been little research into harms and distress in ME/CFS.

“Engel et al. hoped that the biopsychosocial model would move the focus of medicine away from viewing illness in terms of disease pathology, to a more patient-centred approach that takes account of the individual, their life-course, social history and mental health.”


“Ironically, ME/CFS patients argue that the BPS model applied to their illness downplays the important role of biological abnormalities and over-states the role of psychological and social factors.”

ME/CFS and the biopsychosocial model (2018)


“Our paper sought to investigate the types of harms and distress reported in the literature. The sociologist Ivan Illich published a controversial book, Medical Nemesis, that argued that doctors and the medical community commonly cause harm to patients, not just at the level of the individual patient, but also on a societal level. Such views move harm far beyond simple medical error…”
 
one comment on the MEA summary page
One thought on “MEA Summary Review: ME/CFS and the Biopsychosocial Model – By Dr Keith Geraghty | 29 June 2018”
  1. d8030e355de60973f20787322e658f79
    tinalouiseJuly 3, 2018 at 2:57 pm
    I have CFS/ME. I am an occupational therapist primarily working with people who have had a stroke or traumatic brain injury. Occupational therapists are trained to use a BPS model which is holistic and integrated, and where rehabilitation is much more of a partnership between the professional the individual and their carers. I have never known it be referred to as “controversial” as it has been in this article. I use it in my practice because it acknowledges that humans are not just a set of symptoms but that we have a mind, that we live in a specific environment and in a wider community. All of these factors need to be taken in to account whether you have had a stroke or have ME. the fact that most health professionals ignore the “bio” part of the BPS model is not a fault of the model but of its application. To suggest we go back to a medical model (used by most NHS GP’s) is throwing the baby out with the bath water. I am sure that most people with CFS/ME recognise that the biomedical cause and effect model is too limited to address the many varied symptoms of any complex long term illness, including ME/CFS.
 
NelliePledge said:
one comment on the MEA summary page
One thought on “MEA Summary Review: ME/CFS and the Biopsychosocial Model – By Dr Keith Geraghty | 29 June 2018”
  1. d8030e355de60973f20787322e658f79
    tinalouiseJuly 3, 2018 at 2:57 pm
    I have CFS/ME. I am an occupational therapist primarily working with people who have had a stroke or traumatic brain injury. Occupational therapists are trained to use a BPS model which is holistic and integrated, and where rehabilitation is much more of a partnership between the professional the individual and their carers. I have never known it be referred to as “controversial” as it has been in this article. I use it in my practice because it acknowledges that humans are not just a set of symptoms but that we have a mind, that we live in a specific environment and in a wider community. All of these factors need to be taken in to account whether you have had a stroke or have ME. the fact that most health professionals ignore the “bio” part of the BPS model is not a fault of the model but of its application. To suggest we go back to a medical model (used by most NHS GP’s) is throwing the baby out with the bath water. I am sure that most people with CFS/ME recognise that the biomedical cause and effect model is too limited to address the many varied symptoms of any complex long term illness, including ME/CFS.
Click to expand...

I think Tina displays all the cognitive dissonance of a CFS/ME clinic!
 
I use it in my practice because it acknowledges that humans are not just a set of symptoms but that we have a mind, that we live in a specific environment and in a wider community. All of these factors need to be taken in to account whether you have had a stroke or have ME.
Click to expand...

I'm not aware of any model of disability that denies that humans are more than a set of symptoms, have a mind, live in a specific environment etc. The problem with the biopsychosocial model is that it seems to encourage doctors, OTs, etc to imagine that they are able to understand how all these factors should be taken into account in the way that their patients are treated, when very often they're acting on nothing more than a series of hunches and prejudices that would be best put to one side. If medical staff were all perfect, the biopsychosocial model might very well be a good thing, but as things are, attempts to adopt a biopsychosical model often do more harm than good.
 
Last edited:
NelliePledge said:
All of these factors need to be taken in to account whether you have had a stroke or have ME.
Click to expand...

No they don't. Unless the patient specifically requests it. Even then the things on offer should be based on informed consent and should be objectively evidenced based. The problem with state employees in certain capacities is that they use appeal to authority and even assume a authority over the patient whilst pretending it's a "joint patient/therapist" relationship. Even if the whole model is moronic there will be numbers of people who just accept it in blind faith.

The fact that most health professionals ignore the “bio” part of the BPS model is not a fault of the model but of its application.
Click to expand...


It is the fault of the model because the model is designed as a brand so that repeaters like her think it has some objective value. She is proving that very point by her own words.


To suggest we go back to a medical model (used by most NHS GP’s) is throwing the baby out with the bath water.
Click to expand...

Just throw out the bath water keep the baby that's the whole point. The bathwater is the garbage BPS model of collecting tick box questions designed to make ones service appear to be doing something objective.

I am sure that most people with CFS/ME recognise that the biomedical cause and effect model is too limited to address the many varied symptoms of any complex long term illness, including ME/CFS.
Click to expand...

Bollocks! Shows how much she knows about the objective facts of GET and CBT in ME.

If writing to employers to ask for a better chair or coming out to your house to permit you a handrail near your toilet is the extent of occupational therapy it shows what gobshite it actually is. You might even find doctors blocking such things on the grounds of denial of the biological in ME.

This holistic model nonsense is more likely to end up as state control gatekeeping over what you can and cannot be granted when the logistics of what a given person needs is common bloody sense. Why should people have to go cap in hand to "occupational therapists" to be adjudicated over by the state gatekeepers who at best provide common bloody sense but at worst can impose regimes on people that make them worse because of their ignorance.

Why not just have a biohomeofaithreiki BHFR model and then just say, lets not throw out the baby with the bathwater.

Seems to me this is like saying lets chuck out bad homeopaths/faith healers/reiki masters and only keep the good ones.

Pseudoscience is pseudoscience there's no good pseudoscience.

People can choose all sorts of things with their own will with informed consent but garbage should not be part of the public health policy model.
 
Last edited:
Tina, how would you describe your approach? Perhaps you consider it important not just to address the medical needs of the patient, but also their social and physical environment - for example, educating their families on how they can support their loved ones, and offering advice on physical modifications to the home environment that may make their lives easier?

If your approach is something like this - an integrated approach - then say that. Just don't use the word "biopsychosocial" as it means so many different things to different people - and in ME/CFS, it is used to provide cover for a whole host of harmful practices.

I think the label "biopsychosocial" should be banned, and all practitioners should be encouraged to state what their approach is in words.
 
Woolie said:
Tina, how would you describe your approach? Perhaps you consider it important not just to address the medical needs of the patient, but also their social and physical environment - for example, educating their families on how they can support their loved ones, and offering advice on physical modifications to the home environment that may make their lives easier?

If your approach is something like this - an integrated approach - then say that. Just don't use the word "biopsychosocial" as it means so many different things to different people - and in ME/CFS, it is used to provide cover for a whole host of harmful practices.

I think the label "biopsychosocial" should be banned, and all practitioners should be encouraged to state what their approach is in words.
Click to expand...
In case you missed it, the comment was posted on the ME Association website. You could post your comment there also.
 
Difficulties in accessing the sick role, medical care and social support

The biopsychosocial framework is increasingly used to assess ME/CFS patients’ right to adopt the ‘sick role’ [53,54]. In the UK, doctors play a role in assessing claimants for sickness benefits and advise Government on social policies. The biopsychosocial model has been used to develop a training manual of the UK Department for Work and Pensions (DWP) for disability analysts [55]; has helped shape NICE guidelines for ME/CFS [2]; and has been used to design guidelines for medical insurance claims assessors in the Netherlands [56–58]. In this regard, BPS perspectives are being used in assessing patients’ rights to access medical and social care. Interestingly, sufferers often report finding it difficult to access sickness benefits [31,32].
Click to expand...
 
Woolie said:
I think the label "biopsychosocial" should be banned, and all practitioners should be encouraged to state what their approach is in words.
Click to expand...

There's only correct medical advice or incorrect medical advice.

Biopsychosocial is just a bollocks word, it allows any claim to be made without that claim needing to be falsified.

The other favourite word from this kind of nonsense is "multidisciplinary". Which just means referring on, ignoring and dumping and lumping together.

It's not scientific and it impairs scientific development.
 
I am a registered nurse and when I was trained we learned about the bio-psycho-social model of care. I believe it is thought across all allied health care fields.

i believe there is a time to address ‘bio-psycho-social’ dimensions, usually it is when the patient asks for it. The medical and physical needs always come first.

There has been trends as of late for physicians to address psycho-social needs, coming from accreditation agencies, so I hear. Also my government has given a lot of money as of late for mental health, and I believe it is the trend in the UK as well.

In the context of our disease, I find addressing psycho-social needs first instead of performing testing to find out what the heck is wrong, or planning research or clinical trial, is an insult and complete disregard of what is most needed, competent medical care, mere curiosity from physicians to find out what is going wrong in each of us. Instead we are being hearded in group therapy to learn about grieving and managing our symptoms, and to get education about central sensitization.

Governments, socialized health care systems, and insurance companies know that by not addressing a disease at a medical level, they are saving themselves billions of dollars. They can simply do symptom management and call this health care.

While addressing psycho-social needs is important (and I will include access to disability insurance and social benefits in this category), it is usually not on the top of the priority list when someone presents with ME. Just like someone with a stomach ulcer does not need to see a psychologist as first intervention.

Then this begs the question: what do you need and how do you want to be treated?
 
Last edited:
You must log in or register to reply here.
Back
Top Bottom