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Using the Biopsychosocial Model to Guide Patient-Centered Neurological Treatments, 2022, Saxena, Perez et al

Discussion in 'Other psychosomatic news and research' started by Andy, Feb 4, 2022.

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  1. Andy

    Andy Committee Member

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    Abstract

    The biopsychosocial model was defined by George L. Engel to propose a holistic approach to patient care. Through this model, physicians can understand patients in their context to aid the development of tailored, individualized treatment plans that consider relevant biological, psychological, and social–cultural–spiritual factors impacting health and longitudinal care. In this article, we advocate for the use of the biopsychosocial model in neurology practice across outpatient and inpatient clinical settings. To do so, we first present the history of the biopsychosocial model, and its relationships to precision medicine and deep phenotyping. Then, we bring the neurologist up-to-date information on the components of the biopsychosocial clinical formulation, including predisposing, precipitating, perpetuating, and protective factors. We conclude by detailing illustrative neurological case examples using the biopsychosocial model, emphasizing the importance of considering relevant psychological and social factors to aid the delivery of patient-centered clinical care in neurology.

    Paywall, https://www.thieme-connect.de/products/ejournals/abstract/10.1055/s-0041-1742145
     
    Andy, Feb 4, 2022
    #1
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  2. Sean

    Sean Moderator Staff Member

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    Oh shit, it's metastasizing. It used to only be the 3 Ps.
     
    Sean, Feb 4, 2022
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    EzzieD, Mithriel, Midnattsol and 12 others like this.
  3. chrisb

    chrisb Senior Member (Voting Rights)

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    It has been up to four before. I think the fourth used to be prognostic, but I never understood it.
     
    chrisb, Feb 4, 2022
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  4. Hutan

    Hutan Moderator Staff Member

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    I would have thought an important 'p' word in the 'biopsychosocial clinical formulation' for neurologists to be up to date on was profitability. As in, how can you produce maximum revenue and honours with the least amount of effort? The move to online courses was a major advance in the history of the BPS clinical formulation, removing the tedium of actually having to spend time with those people with their annoying perpetuating factors, and minimising the cost of service delivery.
     
    Last edited: Feb 4, 2022
    Hutan, Feb 4, 2022
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  5. Trish

    Trish Moderator Staff Member

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    The actual original BPS model seems pretty sensible to me. If I remember correctly, an example Engels gave was a man having a heart attack who delays getting help because of psychosocial factors and therefore has a worse outcome.

    Somehow this has morphed into a whole industry where if an immediate 'bio' explanation for symptoms isn't found, that then gets dumped completely and focus is exclusively on digging inappropriately into the patient's psyche, blaming them for not getting better, and persuading them to take part in unevidenced psychological and behavioural treatments.
     
    Trish, Feb 4, 2022
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  6. shak8

    shak8 Senior Member (Voting Rights)

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    Exactly, @Trish. I remember when that term was born--read about it in coursework for nursing or psych or medical in general. It sounded right and good.

    Concepts drift (to the lowest common denominator-brain) and pick up all flotsam on their journey. Time for this one to dock permanently and be dismantled.
     
    shak8, Feb 4, 2022
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  7. rvallee

    rvallee Senior Member (Voting Rights)

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    The BPS model explicitly ignores all context, asking generic questions that make no difference whether someone has reasons to "worry" or not. It could not be any further from this pretense. Even allowing for psychosocial factors to be relevant, socioeconomic and environmental factors are 10-100x more important.

    It's hard to tell whether they're knowingly lying or ate the onion, because it really stretches disbelief to accept that someone smart can actually think that reducing people to vague, generic interpretation of biased questionnaires is "holistic" in any shape or form, especially when the goal is to dismiss the entire medical context. It's basically like insisting that a stick figure drawing is a more accurate depiction of someone than a photo. What a bunch of dogmatic nonsense.
     
    rvallee, Feb 4, 2022
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  8. chrisb

    chrisb Senior Member (Voting Rights)

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    I have only looked through the references. I find it alittle strange that they purport to provide a history of "the" BPS model. Somehow they omit any reference to McHugh and Vallis, Cott, Eisenberg and Kleinmanet al. Without that it is hardly possible to understand the changes which have occurred in the use of the term.
     
    chrisb, Feb 5, 2022
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  9. rvallee

    rvallee Senior Member (Voting Rights)

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    No True Biopsychosocial.

    Literally this has been one of the main lines of whining, especially related to the NICE guidelines: those who deteriorated only deteriorated because their program was wrong (even though of course it was exactly as they designed it). And how do you know a program was truly biopsychosocial? If it works, of course. Winning by circular default reasoning, so hot right now.
     
    rvallee, Feb 5, 2022
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  10. Sean

    Sean Moderator Staff Member

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    Exactly.

    The basic BPS construct is nothing more than the medical version of the core scientific principle that all relevant significant causal factors need to be identified and taken into account to properly explain a phenomenon.

    So when are the psycho-social advocates going to implement that principle consistently and robustly?

    Where, for example, are their clinical trials testing how much of the psycho-social (and medico-legal) burden on patients is imposed by decades of reckless inappropriate psychologisation and its consequences, including inadequate and precarious material support, extreme social stigma and hostility, and the constant threat of being further inappropriately psychologised?

    Love to see the true effect sizes for those kind of, um, not insignificant variables.

    The BPS club wish to invoke BPS proper?

    Bring. It. On.
     
    Sean, Feb 6, 2022
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  11. Jaybee00

    Jaybee00 Senior Member (Voting Rights)

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    Jaybee00, Feb 16, 2022
    #11
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  12. Jaybee00

    Jaybee00 Senior Member (Voting Rights)

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    Jaybee00, Feb 16, 2022
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