Barriers to the Integration of Psychosocial Factors in Medicine: Results of a National Survey of Physicians

Abstract

Purpose: Examine physicians' attitudes toward the incorporation of psychosocial factors in diagnosis and treatment and identify barriers to the integration of evidence-based mind-body methods.Method: Random sample of primary care physicians and physicians from selected non-primary specialties was drawn. A total of 1058 physicians completed a 12-page survey.Results: The response rate was 27%. Although a majority of physicians seem to recognize the importance of addressing psychosocial issues, approximately one third believe that addressing such factors would lead to minimal or no improvements in outcomes. A minority reports their training regarding the role of psychosocial factors was effective, and relatively few indicate interest in receiving further training in these areas.Males were less likely to believe in the importance of addressing psychosocial factors. Additional factors included perceptions that training was poor in these areas; feelings of low self-efficacy to address psychosocial issues and the perception that such factors are difficult to control; lack of knowledge of the evidence-base supporting the role of psychosocial factors; and lack of time and inadequate reimbursement to address the psychosocial domain.Conclusions: These results suggest the need for more comprehensive training in the role of psychosocial factors in health. In addition, the finding that physicians identify lack of time and inadequate reimbursement as significant barriers suggests that the current health care delivery system may, in many respects, be antithetical to the biopsychosocial model. (J Am Board Fam Med 2006;19:557-65.)The call for greater recognition of the role of psychological and sociocultural factors in medicine is certainly not new. Engel 1 published a seminal article almost 30 years ago calling for an expansion of the biomedical model to a biopsychosocial one. However, despite such calls for reform, studies suggest that psychosocial factors continue to be overlooked or frequently missed in clinical encounters 2-7 and tend to still be underemphasized in medical education. 8,9 Studies also suggest that empirically supported mind-body interventions for such common health problems as pain and insomnia 10,11 are used by only a minority of patients suffering from these conditions. 12Consistent with these findings, in October 2004, the National Institutes of Health issued a request for applications (RFA) focused on "strengthening behavioral and social science curricula in medical school." This RFA grew out of an Institute of Medicine report issued earlier that same year in which the authors noted that "no physician's education would be complete without an understanding of the role played by behavioral and social factors in human health and disease, knowledge of the ways in which these factors can be modified, and an appreciation of how personal life experiences influence physician-patient relationships."Although there is a growing body of evidence pointing to the role that psychosocial factors such as stress can play i...

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