Saudi Diploma in Family Medicine Center of Post Graduate Studies i n F amily M edicine

1. The Biopsychsosocial Model Saudi Diploma in Family Medicine Center of Post Graduate Studies in Family Medicine Dr. Zekeriya Aktürk zekeriya.akturk@gmail.com www.aile.net / 23

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3. What do you understand from this phrase: “Don’t treat the disease; treat the patient.” / 23

4. Aim-Objectives • Aim: At the end of this presentation, the participants will have knowledge of biopsychosocial medicine and believe on the importance of this model in PC. • Objectives: • Can define systems approach • Can define biopsychosocial model • Is aware of the importance of social, psychological and existential factors on health / 23

5. Ages of medicine • Symptomatic era : • First medicine; every finding a disease • Hipocrattes, Razi, Ibn Sina; the balance of blood, phlegm and bile • Laboratory era • 1880; invention of Rabies virus • Clinical era • Diseases have different course in different patients… • Social medicine • 1848; “Because it is aiming to improve the health of the public medicine should be regarded as a social science…” • “The illness of a person is not solely his/her problem. It will effect others as well.” • Systems approach • Engel 1980; “The human is a complex being; it is difficult to find a single cause for his disease” • Biopsychosocial medicine / 23

6. Ages of medicine • Symptomatic era : • First medicine; every finding a disease • Hipocrattes, Razi, Ibn Sina; the balance of blood, phlegm and bile • Laboratory era • 1880; invention of Rabies virus • Clinical era • Diseases have different course in different patients… • Social medicine • 1848; “Because it is aiming to improve the health of the public medicine should be regarded as a social science…” • “The illness of a person is not solely his/her problem. It will effect others as well.” • Systems approach • Engel 1980; “The human is a complex being; it is difficult to find a single cause for his disease” • Biopsychosocial medicine • “Don’t treat the disease; treat the patient” / 23

7. Is medicine really improving? • Number of laboratory tests increased 33% from 1967 to 1972 • McGinnis 1976 • What about patient satisfaction?? / 23

8. A random case • Jane, 19 y • Doing sports professionally • Has knee injury. The orthopedician applies a treatment. During the follow up visit there is muscle weakness and general symptoms (fatigue, sweating, neck pain). She doesn’t exercise. There is disagreement with the orthopedician. • The family physician discusses the effect of the disease on Jane’s live. A conservative family. Education and success is very important in the family. Siblings very successful. • The injury caused loss of self-esteem • Establishing insight to the disease and discussion established adherence to therapy and she improved soon. McWinney S. 68 ve 173. değiştirilerek / 23

9. Systems hierarchy Population Family, small groups, culture Individual Neuro-endocrine Immune system Organ systems Tissues Cells Melecules / 23 Engel 1980

10. Patients life before knee trauma Conservative Population Family, small groups, culture Individual Neuro-endocrine Immune system Organ systems Tissues Cells Melecules Religious education with a brother of academic success Transition to adulthood, self-esteem due to success in athletism / 23

11. Effect of knee trauma System changes Population Family, small groups, culture Doctor-Patient Individual Neuro-end. Immune sys. Organ systems Tissues Cells Melecules Release of medical resources EventKnee trauma Crisis Disagreement, loss of communication Disrupture of life plan, immobility, pain, anger, depression, irritability Excess autonomic nervous system activity Tachycardia, sweating, weight loss Joint trauma, muscle injury Reaction to trauma / 23

12. Effect of change System changes EventEstablishing therapeutic relationship Population Family, small groups, culture Doctor-Patient Individual Neuro-end. Immune sys. Organ systems Tissues Cells Melecules Release of rehabilitative resources Resolving of crisis, understanding Establishing communication, therapy Understanding the real reason of the problem, rearranging life objectives Return of weight and heart rate, improvement of knee functions Return of weight and heart rate, improvement of knee functions Surgical intervention, release of muscle tension Improvement / 23

13. Biomedical model • Aim: to treat the knee problem and remove the physical pathology underlying the symptoms. • Which is important but not enough • What is needed?: understanding of the patients internal world / 23

14. Another case • 35 y, male • Married • 3 kids • Laborer in a fabric • Gets injured at work • Unable to work for 3 months / 23

15. Systems Thinking • Systematic thinking is often used by scientists. • It makes it easy to understand • For example: • an occupational trauma may be due to inadequate tools (social), loss of attention (psychological) or drop of blood glucose (biological); • causing organ injury (biological), stress (psychological) or loss of income (economical). • However, isolating the problem is not applicable to general practice. A GP has to consider the complex relationship of problems / 23

16. Bio-Psycho-Social Factors • Biologic Factors • Immune System • Endocrine System • Organ Systems • Tissues • … • Social Factors • Community • Family • Culture • ... ORG ANI SM • Psychological Factors • Anxiety • Depression • ... / 23

17. Inadequate organized environment (social) Drop in income (social) Drop in blood glucose(biologic) Organ trauma(biologic) Occupational injury Stress (psychological) Inattentive (psychological) / 23

18. The Biopsychosocial Model • It encourages the clinician to observe the feelings, life objectives, attitude towards the disease, social environment, biochemical and morphologic changes. • The person is a complex of body, mind and social environment. Environmental and psychological conflicts are potential pathologies for the individual. • Feelings can affect physiological functions of the body (Zegans, 1983). • Instead of dealing primarily with biological factors, considering psychological and social factors as well will enable understanding disease processes. / 23 Engel 1977

19. Wonca Europe 2005 • The characteristics of the discipline of general practice/family medicine are that it: • …k - deals with health problems in their physical, psychological, social, cultural and existential dimensions. http://www.woncaeurope.org/ / 23

20. The LEARN Model - Listen with empathy the patients view to his/her problem - Explain the patient on his/her words the view and opinions of the doctor - Acknowledge the differences between the doctor and patients thoughts - Recommend a model integrating the patients as well as doctors opinions - Negotiate to a common solution with medical, ethic, legal acceptability covering the patients expectations / 23 Berlin and Fowkes (1983)

21. Larry Weed : • "You can't get patients well unless you know their psychiatric, medical, and social problems. Don't send them out on a low salt diet for problem #1: heart failure, and problem #5: lives all alone, no heat in the house, cooks his own meals, is 85 and half blind. You don't need to be a cardiologist to know that this wont work." http://www.annfammed.org/cgi/eletters/2/6/576 / 23

22. Summary • Which of the below is wrong regarding the psychosocial model? • The person is evaluated with his family and environment • There are multiple ethiologic dimenstions • It evaluates the person with his body, soul and social environment • It has a disease centered approach / 23

23. What is the main reason medicine moved from the laboratory era to the clinical era? • What is the main idea of the systems approach and how can GPs use it in patient care? • Can you explain the LEARN acronym developed by Berlin and Fowkes? / 23