Construction of a patient narrative (case history) is a core strategy in the care of patients. Recent advances in biomarker identification and digital sensors to monitor physiological and behavioral features have made constructing a case history more complex. Notably, however, although a biological profile is increasingly a part of the patient’s profile, an analogous patient-based biographical (life experience) profile is typically overlooked. Evolving concepts such as allostasis and allostatic load refer to processes promoting stability of physiological systems in the presence of diverse life experiences. Integrating details of both biology and biography is a goal of “precision medicine.” In this review, we describe how complex interactions between biology and biography affect disease risk and treatment response and highlight a strategy to develop narratives that establish the integration of biology and biography as the scientific basis for precision medicine.
Biosocial Medicine, with its emphasis on the full integration of the person's biology and biography, proposes a strategy for clinical research and the practice of medicine that is transformative for the care of individual patients. In this paper, we argue that Biology is one component of what makes a person unique, but it does not do so alone. Biography, the lived experience of the person, integrates with biology to create a unique signature for each individual and is the foundational concept on which Biosocial Medicine is based. Biosocial Medicine starts with the premise that the individual patient is the focus of clinical care, and that average results for “ideal” patients in population level research cannot substitute for the “real” patient for whom clinical decisions are needed. The paper begins with a description of the case-based method of clinical reasoning, considers the strengths and limitations of Randomized Controlled Trials and Evidence Based Medicine, reviews the increasing focus on precision medicine and then explores the neglected role of biography as part of a new approach to the tailored care of patients. After a review of the analytical challenges in Biosocial Medicine, the paper concludes by linking the physician's commitment to understanding the patient's biography as a critical element in developing trust with the patient.
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