A practical assessment of physician biopsychosocial performance

Abstract

Background: A biopsychosocial approach to care seems to improve patient satisfaction and health outcomes. Nevertheless, this approach is not widely practiced, possibly because its precepts have not been translated into observable skills. Aim: To identify the skill components of a biopsychosocial consultation and develop an tool for their evaluation. Methods: We approached three e-mail discussion groups of family physicians and pooled their responses to the question ''what types of observed physician behavior would characterize a biopsychosocial consultation?'' We received 35 responses describing 37 types of behavior, all of which seemed to cluster around one of three aspects: patient-centered interview; system-centered and family-centered approach to care; or problem-solving orientation. Using these categories, we developed a nine-item evaluation tool. We used the evaluation tool to score videotaped encounters of patients with two types of doctors: family physicians who were identified by peer ratings to have a highly biopsychosocial orientation (n ¼ 9) or a highly biomedical approach (n ¼ 4); and 44 general practitioners, before and after they had participated in a program that taught a biopsychosocial approach to care. Results: The evaluation tool was found to demonstrate high reliability ( ¼ 0.90) and acceptable interobserver variability. The average scores of the physicians with a highly biopsychosocial orientation were significantly higher than those of physicians with a highly biomedical approach. There were significant differences between the scores of the teaching-program participants before and after the program. Conclusions: A biopsychosocial approach to patient care can be characterized using a valid and easy-to-apply evaluation tool.

Definition of whole person care in general practice in the English language literature: a systematic review

“…Emphasis on the doctor–patient relationship was prominent within whole person and holistic literature 14 16 27 29 30 32 35 38 39 42 45 48 50 52 54 55 57 66 67 69. Literature on the biopsychosocial approach was mixed, with the doctor–patient relationship emphasised in papers that specifically focused on the practical application of a biopsychosocial approach 46 61 65. An alternative view also existed, that considered the biopsychosocial model an ethically neutral scientific theory rather than an approach to care 41…”

“…These ranged from medication, surgery and physical therapy, to counselling and cognitive therapy, spiritual counselling, compassion, presence and connection. Margalit et al ’s study on the practical application of the biopsychosocial model identified that offering not only medication, but also advice on health promotion and managing emotions characterised a biopsychosocial doctor–patient encounter 46…”

Healthcare providers’ knowledge and use of psychological and psychoSOCIAL screening and interventions in the management of patients with tendinopathy: An International Survey of Practice

“…Research emphasises the necessity for training, mentoring, and practice assessment to enhance competency in this area. [27][28][29] The observed deficiency in formal assessment raises concerns about the accuracy of clinician self-reporting, given their varying competency levels and potential overconfidence. [27,28,30,31] This concern is further compounded when tools are utilised for psychoSOCIAL assessments, as clinicians predominantly resort to psychological patient-reported outcome measures and objective assessments that would normally be considered psychological constructs such as behaviour, fear avoidance and physical literacy.…”

“…[27][28][29] The observed deficiency in formal assessment raises concerns about the accuracy of clinician self-reporting, given their varying competency levels and potential overconfidence. [27,28,30,31] This concern is further compounded when tools are utilised for psychoSOCIAL assessments, as clinicians predominantly resort to psychological patient-reported outcome measures and objective assessments that would normally be considered psychological constructs such as behaviour, fear avoidance and physical literacy. This suggests a potential misinterpretation of psychological and psychoSOCIAL constructs, indicating a need for further training, as highlighted by many respondents expressing a desire for specific training and selfdevelopment.…”

Analysis of Real-World Implementation of the Biopsychosocial Approach to Healthcare: Evidence From a Combination of Qualitative and Quantitative Methods

“…Engel held the view that disease is the result of the interaction of biological, psychological, and social subsystems on multiple levels and highlighted the indispensable role of psychosocial factors, which explained such phenomena as the effect of living conditions on the development of the disease. The premise of the biopsychosocial approach is that the patient's disease cannot be divorced from his or her psychosocial causes, personality, and surroundings ( 2 ). Evidence has shown that social/environmental and psychological factors matter in the development of psychiatric disorders ( 3 ).…”