The holistic approach to healthcare, encompassing biological, psychological, and social factors and their interplay, serves as a comprehensive framework for understanding health and guiding care delivery. While extensively taught in clinical training programs, actual integration across these domains remains a challenge within health systems.

Biological, psychological, and social factors exist along a continuum of natural systems, as depicted in the diagram above and to the left. While we experience the continuous absorption of internal and external stimuli day in and day out, we not only react to our circumstances; but also anticipate future ones. (Really impressive when you think about it). This process is also known as allostasis. The systems that encompass all internal and external factors are our Biological systems (bodily health) Psychological System (Mental and emotional wellness) and Sociological Factors (Social interactions and community).

BIO-MEDICINE considers our Biology and medicine, but has left out the psychological and sociological factors for too long. It is time for a new, more encompassing approach. Though its validity has been supported with vast research; the biopsychosocial model remains low in viability. To measure and fund such an approach would be an incredible change to our society.

So we are left with the question; is this even necessary?

With chronic diseases now accounting for most morbidity and many deaths in Western countries, healthcare systems designed around acute biomedical care models are struggling to improve patient-reported outcomes and reduce healthcare costs. Consequently, there is now a greater need to apply the biopsychological model to healthcare management.

Biomedicine (Traditional Medicine):

- Focus: Primarily focuses on biological factors such as genetics, pathology, and physiology.

- Approach: Views health and illness as primarily caused by biological mechanisms like viruses, bacteria, or genetic predispositions.

- Treatment: Treatment often involves medications, surgeries, or other interventions targeting biological processes.

-*Example: If a person has high blood pressure, biomedicine might focus on prescribing medication to lower it without considering other factors.

Biopsychosocial Model (Engel's Model):

- Focus: Considers biological, psychological, and social factors as interconnected and equally important in understanding health and illness.

- Approach: Recognizes that health and illness are influenced by a complex interaction of biological, psychological, and social factors.

- Treatment: Treatment involves addressing not only biological factors but also psychological and social aspects such as stress, lifestyle, and social support.

- Example: When treating high blood pressure, the biopsychosocial model might also consider factors like stress levels, lifestyle habits, and social support networks.

LETS BREAK IT DOWN

Biological Traits

Genetic predispositions:Inherited characteristics that may increase the risk of developing certain diseases.

Physiological states: The body’s physical condition and functioning, including hormone levels, immune system status, and presence of infections or diseases.

Anatomical characteristics: Physical structures and organs, including abnormalities or injuries.

Biochemical processes: The chemical processes and substances in the body, such as neurotransmitter levels or nutrient deficiencies.

Psychological Traits

Stress levels:The degree of stress a person experiences and how they manage it.

Mental health state:The presence of mental health disorders (e.g., depression, anxiety) or a healthy mental state.

Cognitive functions:Abilities related to thinking, reasoning, memory, and decision-making.

Emotional well-being: The range and intensity of emotions, emotional regulation, and the presence of positive feelings like happiness and contentment.

Sociological (Social) Traits ( the most important)

-Social support networks: The presence and quality of relationships with family, friends, and community.

Cultural factors:Beliefs, values, and practices that influence health behaviors and perspectives, including dietary habits, physical activity, and attitudes toward healthcare.

-Socioeconomic status: The impact of income, education, and occupation on access to healthcare, nutrition, and living conditions.

-Lifestyle and behaviors:Choices and habits related to diet, exercise, substance use, and recreational activities.

Reasons why the biopsychosocial model may be less common in clinical settings:

1. Complexity: Implementing the biopsychosocial model requires considering a wide range of factors, which can be challenging and time-consuming in busy clinical settings.

2. Training: Many healthcare professionals receive training that primarily focuses on biomedical approaches, leading to a lack of expertise in integrating psychological and social factors into patient care.

3. Resource Constraints: Healthcare systems may lack resources such as time, personnel, and funding to support comprehensive biopsychosocial assessments and interventions.

4. Stigma: There may still be stigma or skepticism surrounding the importance of psychological and social factors in healthcare, leading to a reluctance to adopt the biopsychosocial model.

While the biopsychosocial model has been validated by research and offers a more holistic approach to patient care, its implementation in clinical settings may be limited by various challenges and barriers.

To apply the biopsychosocial approach to clinical practice or wellness services, the clinician or trainer should:

• Recognize that relationships are central to providing health care.

• Use self-awareness as a diagnostic and therapeutic tool • Elicit the patient’s history in the context of life circumstances

• Decide which aspects of biological, psychological, and social domains are most important to understanding and promoting the patient’s health.

• Provide multidimensional treatments.

REFERENCES

Engel GL: The need for a new medical model: a challenge for biomedicine. Science 1977;196:129-136.

Engel GL: The clinical application of the biopsychosocial model. Am J Psychiatry 1980;137:535-544.

Frankel RM, Quill TE, McDaniel SH (Eds.): The Biopsychosocial Approach: Past, Present, Future.University of Rochester Press, Rochester, NY, 2003.

Borrell-Carrió F, Suchman AL, Epstein RM: The biopsychosocial model 25 years later: principles, practice, and scientific inquiry. Ann Fam Med 2004;2:576-582.

Cohen J, Brown Clark S: John Romano and George Engel: Their Lives and Work.University of Rochester Press, Rochester, NY, and Boydell and Brewer Limited, Suffolk UK, 2010.