George L. Engel's Biopsychosocial Model

As a medical student, it is apparent to me that we are constantly inundated with learning, be it physiology, anatomy, or biochemistry, but also at the forefront of our learning ought to be how to develop a compassionate approach to medicine and a commitment to the understanding of our patients. Doctors nowadays in the modern world are often perceived as brusque and indifferent, which are traits never to be envied in a physician. Galen believed that alongside all the scientific knowledge we are taught, that we should “add philosophy, especially ethics and logic in the broad sense, components which he would undoubtedly see as unduly neglected in modern times”. One of the most vital qualities of a physician is an interest in humanity and the ability
to listen and empathise with their patients. Throughout our BH1002 lectures and tutorials thus far, we have gained a handful of useful insights into patient care, and how important compassion will be in our future work. We were taught about several concepts which when utilised will allow us to understand patients better and enable us to show them more compassion. As it is commonly said, the biggest mistake a doctor can make is in not caring, not in not knowing.
A clinician’s desire to help is integral to their compatibility to their profession. As doctors, we will not always be able to restore a patient to their full physical health but we will always be able to console and care for our patient’s mental wellbeing. In accordance with the biopsychosocial model we must always identify that an illness has biological, psychological and sociological dimensions, as stated by the founder of the model, George L Engel. He believed that “to provide a basis for understanding the determinants of disease and arriving at rational treatments and patterns of healthcare, a medical model must also take into account the patient, the social context in which he lives, and the complementary system devised by society to deal with the disruptive effects of illness, that is, the physician role and the healthcare system.” We should too endeavour to work successfully alongside other healthcare professionals as a team and be compassionate towards them along with our patients. We discovered communication will be key in our everyday work and that communication helps provide high quality
service. Doctors should also ensure that the technological advances of our times are utilised to their full potential and that they do not create barriers between patient and doctor, and that communication patient and doctor still remains personal and intimate.

The etymology of the word compassion is Latin, and literally means “co-suffering”. Compassion is the evoking of an emotional resonance with someone and their suffering, and too evoking an ambition to lighten their suffering. We must be able to put ourselves in the shoes of the patients and attempt to understand their fear, pain and distress. Alas, the question is often posed to doctors, is there such thing as being too compassionate? Should doctors remain detached? Recorden wrote of how important communication and compassion is in the patient-doctor relationship and how powerful it can be in strengthening a relationship but how doctors must also be to remain objective and still be able to perform to the best of their abilities. It is our duty to always remember the caring and empathic nature of the profession. As Maimondes famously said, “May I never see in the patient anything but a fellow creature in pain.”

An indispensable key in being able to combine our scientific knowledge with compassion in our future work, is the knowledge, understanding and application of the biopsychosocial model. This model states that in order to provide patients with care of the highest standards we must diagnose and identify all aspects of each individual patient’s condition. Doctors must be benevolent and look at the greater picture and not just focus on the actual disease but more so the illness, which is subjective to each patient. A physician must be able to understand that “psychological and social factors influence biological functioning and play a role in health and illness also.” Clinicians sometimes become obsessed and preoccupied with solely the biomedical dimension of the illness, and overlook the biopsychosocial model’s teachings. BH1002 has taught me to always remember the patient’s autonomy, and to always act with beneficence and non-maleficence and to act justly, whilst always applying Engel’s model. In doing all of this in the future, I believe it will help me excel in showing compassion to my patients.

In order to provide patients with an all-encompassing and efficient healthcare system, all healthcare professionals must communicate effectively. It is vital that teamwork occurs, teamwork amongst the doctors, nurses, other healthcare professionals, patients, families and too the wider society. We must show compassion to all so that all members feel included, valued and important in any decision making processes. Clinicians must realises that the strength and quality of relationships with co-workers and with patients and their families plays a huge role in healthcare. When emotional connections form, it allows everyone to resonate with each other and feel cared for and understood. Relationships formed in the healthcare system are more often than not formed upon a reciprocal basis, if the doctor trusts and is compassionate towards the patient, the patient usually reciprocates this behaviour, allowing for a successful and professional service to be provided. Trust is a core aspect of the patient-doctor relationship, patients must feel they can trust and confide in their physician before fully disclosing personal or private information. If all the relevant information is not disclosed to a clinician, an accurate diagnosis cannot be made Sometimes patients become lost and/or forgotten about in the decision making process and we cannot allow this to happen, we must apply our interpersonal skills alongside our compassionate nature and provide the patient with the most apt and suitable treatment as desired by them.

A lack of communication in the workplace leads to an increased likelihood of mistakes and malpractice, as I discovered in our lecture on handover. I learned that in order to be an efficient and caring doctor and to avoid mistakes, the SBAR mnemonic is key and aids the doctor in their handover to other healthcare professionals. The mnemonic stands for situation, background, assessment and recommendation. It is important to have standardised communication mechanisms and adopt a mechanism like SBAR, so risk factors are reduced and we can work effectively together as a team. Research shows that “the adoption of standardised tools and behaviours is a very effective strategy in enhancing teamwork and reducing risk.”

The technology at the fingertips of today’s physicians would have been unimaginable by doctors of the past. This technology enables us to make quicker and more accurate diagnoses, and to store and view our files and information in a simpler format. While I believe this technology should be utilised to its full potential I believe we must also ensure this technology does not build barriers between doctor and patient or take away from the holistic nature of medicine. In the past the typical depiction of a doctor, is a concerned person at the bedside of the ill, caring for and doing their best to alleviate their suffering. This depiction can be seen in Sir Luke Fildes’ 1887 painting “The Doctor”, which we analysed in one of our BH1002 tutorials. It depicts a typical patient-doctor encounter of the 19th Century, and sheds light on the compassionate and caring nature of medicine. “This painting is an eloquent portrayal of what medicine is all about- the doctor, the patient, and the quality of the relationship that exists between them. The physician is attending the patient, watching and waiting- being there. Much of the painting’s impact is the space between the physician’s eyes and the child, which is filled, solely, by the gaze.” Nowadays doctors don’t treat patients in such a hands on method, instead patients often spend much of their time talking to the back of a computer screen. Patients often feel dehumanized and like they are being scrutinized like a specimen under a microscope. Doctors need to engage with patients and listen attentively. Listening is key in comforting and supporting your patients. “Listening is one of the most important aspects of feeling that we are being treated as people and that our thoughts and opinions matter.” BH1002 has taught me to always preserve the patient’s personal dignity and to never become dispassionate towards them.

In conclusion, BH1002 has given me several insights into concepts which I will utilise in my future career, to combine my scientific learning with compassion, in order to treat patients to the best of my abilities.
I learned to above all use compassion in treatment of patients, and to fully understand how much empathy and benevolence can help someone who is suffering. I unearthed how the biopsychosocial model works and how to apply it to my future practice of medicine. BH1002 taught me how communication is integral in order to being compassionate in my work and how in contrast a lack of communication can have a drastic and polarising impact. A standardized mechanism in the workplace, helps prevent errors made in handover or communication in general and allows all professional parties involved to have a regulated means of communication to abide by. Teamwork and trust are vital for providing a professional health care service. Listening and acting as a confidant for the patient too, is an effective mechanism of being compassionate. Also, technology should be used as an asset and not a hindrance to caring for the patient. Peabody said, “young graduates have been taught a great deal about the mechanism of disease, but very little about the practice of medicine- or, put it more bluntly, they are too “scientific” and do not know how to take care of patients”, I do believe that the advances in our scientific and medical knowledge has caused this to occur in the past, modules such
as BH1002 are equipping the medical graduates of today’s generation with the correct tools to combine this high level of knowledge with appropriate and compassionate bedside mannerisms in order to comfort and console their patients to the highest levels. As stated in the modernised Hippocratic Oath, a good physician ought to “remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon’s knife or the chemist’s drug.”